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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Bradley Olson"},"modifier_information":[{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"QHP Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access PPO/Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Illinois PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Advantage Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6384.21,"maximum":25250.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9996.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10632.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25250.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20200.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14746.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7230.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24956.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6384.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7300.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12822.13,"maximum":49939.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19769.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49939.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39950.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29163.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49356.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14439.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7045.98,"maximum":26791.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10606.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11281.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26791.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21433.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15645.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26478.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":21688.87,"10th_percentile":21688.87,"90th_percentile":21688.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12964.43,"10th_percentile":12964.43,"90th_percentile":12964.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4534.98,"maximum":17221.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6817.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7251.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17221.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13777.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10057.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4931.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17020.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4534.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4979.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13955.16,"maximum":53605.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21221.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22571.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53605.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42883.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31304.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15348.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52979.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15499.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7684.83,"maximum":29600.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11718.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29600.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23679.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17285.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29254.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8558.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5422.35,"maximum":21871.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8658.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9209.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21871.59},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17497.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12772.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21616.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5422.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5131.57,"maximum":19871.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7866.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8367.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19871.84},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15897.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11604.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5689.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19639.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5131.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7464.95,"maximum":27892.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11042.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27892.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22313.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16288.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7986.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27567.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8064.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12517.03,"maximum":48439.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19176.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20396.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48439.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38751.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28287.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47873.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12517.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14005.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5326.38,"maximum":19145.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7579.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8061.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19145.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15315.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11180.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18921.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5326.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5535.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7078.2,"maximum":27324.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10817.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11505.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27324.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21859.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15956.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7823.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27005.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7900.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11831.62,"maximum":43489.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17216.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18312.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43489.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34790.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25396.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42981.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18514.96,"maximum":65956.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26110.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27772.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65956.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52764.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38517.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18885.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65186.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19070.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26370.19,"maximum":93939.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37188.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39555.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":93939.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":75150.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54858.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26897.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92842.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27161.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9175.24,"maximum":38189.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15118.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16080.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38189.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30551.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22301.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37743.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9175.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9758.94,"maximum":36744.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14546.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15471.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36744.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29394.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21457.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36315.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.94},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12302.88,"maximum":45961.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18195.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19353.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45961.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36768.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26840.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13160.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45424.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20943.84,"maximum":79279.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31385.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33382.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":79279.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63423.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46297.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22700.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78354.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20943.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22255.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22922.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7942.66,"maximum":31903.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12629.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13433.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31903.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25522.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18630.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9134.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31530.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.66},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9224.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10425.01,"maximum":41647.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16487.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17536.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41647.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33317.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24321.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41161.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10425.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12041.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17188.8,"maximum":68076.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26949.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":68076.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":54460.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39755.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67281.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19110.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19683.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6676.52,"maximum":23783.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9415.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10014.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23783.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19026.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13889.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6810.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23506.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6988.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9320.63,"maximum":35755.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14154.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15055.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35755.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28603.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20880.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35337.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10338.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17604.67,"maximum":62713.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24826.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26407.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":62713.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":50170.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36623.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17956.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61981.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18256.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18132.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9096.82,"maximum":32405.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12828.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13645.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32405.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25924.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18924.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9278.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32027.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9369.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11033.78,"maximum":41106.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16273.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17309.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41106.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32885.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24005.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40626.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11885.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19626.74,"maximum":70559.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27932.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29710.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":70559.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":56447.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41205.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20203.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69735.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19626.74},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19807.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20401.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10717.22,"maximum":41934.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16601.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17657.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41934.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33547.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24488.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12007.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41445.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12124.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":19980.0,"10th_percentile":19980.0,"90th_percentile":19980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15078.16,"maximum":57607.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22805.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24257.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57607.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46085.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33641.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16494.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56934.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15078.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16656.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25604.15,"maximum":97553.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38619.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41077.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97553.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":78042.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56969.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27932.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96414.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25604.15},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28206.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11495.73,"maximum":44745.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17713.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18841.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44745.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35796.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26130.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12812.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44223.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14893.38,"maximum":63986.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25330.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":63986.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":51188.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37366.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18321.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63239.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14893.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18500.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26172.1,"maximum":98913.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39157.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41650.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":98913.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":79130.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57763.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28322.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97758.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26172.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27766.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28599.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11974.86,"maximum":45975.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18200.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19358.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45975.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36779.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26848.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13164.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45438.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.86},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13293.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":94089.98,"10th_percentile":94089.98,"90th_percentile":94089.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16988.98,"maximum":65489.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25925.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65489.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52390.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38244.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18751.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64724.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16988.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18383.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18935.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16078.29,"10th_percentile":16078.29,"90th_percentile":16078.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":131661.06,"10th_percentile":131661.06,"90th_percentile":131661.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19917.5,"10th_percentile":19917.5,"90th_percentile":19917.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32349.32,"maximum":125571.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49711.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52874.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":125571.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":100456.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73331.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35954.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124105.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32349.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35249.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36307.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31234.9,"10th_percentile":31234.9,"90th_percentile":31234.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11439.86,"maximum":43773.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17328.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18431.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43773.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35018.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25562.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12533.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43262.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.86},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":7792.0,"10th_percentile":7792.0,"90th_percentile":7792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17886.38,"maximum":66773.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26434.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28116.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":66773.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":53417.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38994.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19119.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65993.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36375.8,"maximum":136250.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53938.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57371.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":136250.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":108999.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79567.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39012.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134659.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36375.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38247.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39395.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18938.48,"maximum":87704.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34720.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36930.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":87704.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70163.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51217.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25112.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86680.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18938.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25358.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21261.11,"maximum":86082.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34078.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36246.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86082.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":68865.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50270.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85077.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21261.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24889.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29650.68,"maximum":118220.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46800.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49779.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":118220.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":94575.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69038.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33850.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116839.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29650.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33186.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34181.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13059.19,"maximum":48163.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19066.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20280.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48163.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38530.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28126.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13790.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47601.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13059.19},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13925.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20588.6,"maximum":74329.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29425.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31298.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":74329.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":59463.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43406.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21282.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73461.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20588.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21491.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15942.61,"maximum":65710.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26013.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27668.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65710.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52567.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38373.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18814.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64943.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15942.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18999.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31239.93,"maximum":121921.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48266.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51338.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":121921.97},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":97536.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71199.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34909.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120498.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31239.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34225.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35252.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18575.54,"maximum":66172.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26196.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27863.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":66172.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52937.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38643.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18947.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65399.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18575.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19132.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51277.92,"maximum":182668.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72314.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76916.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":182668.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":146133.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106674.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52303.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":180535.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51277.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52816.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4961.12,"maximum":18634.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7376.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7846.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18634.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14907.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10882.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5335.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18416.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4961.12},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6927.8,"maximum":26316.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10418.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11081.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26316.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21052.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15368.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26009.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7609.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14993.65,"maximum":56965.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22551.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23986.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56965.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45572.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33266.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16310.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56300.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14993.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15991.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5182.42,"maximum":19669.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7786.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8282.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19669.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15735.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11486.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5632.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19440.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5182.42},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5687.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":13342.34,"10th_percentile":13342.34,"90th_percentile":29496.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6184.39,"maximum":23811.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9426.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10026.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23811.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19048.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13905.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6817.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23533.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6884.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4999.79,"maximum":19175.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7591.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8074.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19175.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15340.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11197.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5490.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18951.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4999.79},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3960.59,"maximum":15465.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6122.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6512.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":15465.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":12372.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9031.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15284.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3960.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4341.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3805.81,"10th_percentile":3805.81,"90th_percentile":3805.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5333.54,"maximum":20098.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7956.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8462.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20098.59},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16078.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11737.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5754.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19863.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5811.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":5650.42,"10th_percentile":5650.42,"90th_percentile":5650.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":23128.31,"10th_percentile":23128.31,"90th_percentile":23128.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8610.16,"maximum":32892.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13021.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13849.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32892.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26313.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19208.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9417.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32508.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8610.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9510.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6750.9,"maximum":24947.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9876.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10504.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24947.71},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19957.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14568.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24656.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11006.56,"maximum":43049.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17042.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18126.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43049.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34439.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25139.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42546.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11006.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5396.57,"maximum":20628.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8166.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8686.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20628.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16502.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12046.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5906.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20387.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5396.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5964.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15576.42,"10th_percentile":15576.42,"90th_percentile":15576.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8229.14,"maximum":32509.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12869.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32509.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26007.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18984.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32130.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8229.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4713.31,"maximum":18391.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7280.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7744.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18391.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14712.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10740.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5265.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18176.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4713.31},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5162.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5317.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8029.32,"maximum":32689.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12941.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13764.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32689.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26151.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19090.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9360.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32308.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9451.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":23988.62,"10th_percentile":23988.62,"90th_percentile":23988.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5083.59,"maximum":19661.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7783.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8278.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19661.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15729.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11481.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5629.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19431.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5083.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5684.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7641.85,"maximum":29163.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11545.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12279.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29163.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23330.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17030.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8350.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28822.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8432.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11288.74,"maximum":44603.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17657.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44603.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35682.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26047.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12771.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44082.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11288.74},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3149.13,"maximum":12432.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4921.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5235.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":12432.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":9946.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7260.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3559.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12287.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3149.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3490.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3594.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4862.07,"maximum":17320.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6856.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7293.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17320.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13856.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10114.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4959.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17118.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5218.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5007.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11482.12,"maximum":42669.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16891.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17967.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42669.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34135.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24918.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12217.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42171.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11482.12},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12337.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4021.46,"maximum":15462.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6121.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":15462.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":12369.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9029.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4427.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15282.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4021.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6134.25,"maximum":23193.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9181.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9766.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23193.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18554.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13544.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22923.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6134.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6706.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9195.29,"maximum":35072.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13884.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14767.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35072.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28057.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20481.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34662.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9195.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":12012.53,"10th_percentile":12012.53,"90th_percentile":12012.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7544.2,"10th_percentile":7544.2,"90th_percentile":7544.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9344.98,"10th_percentile":9344.98,"90th_percentile":9344.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7129.75,"maximum":25398.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10054.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10694.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25398.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20318.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14832.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25101.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7343.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10583.29,"maximum":46630.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18460.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19635.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46630.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37304.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27231.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46086.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10583.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13482.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18571.07,"maximum":73930.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29267.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31130.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":73930.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":59144.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43173.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73067.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18571.07},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21376.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7746.42,"maximum":29234.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11573.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12309.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29234.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23387.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17072.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8370.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28892.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.42},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8452.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15438.41,"maximum":60451.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23931.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25454.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":60451.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":48360.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35302.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59745.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15438.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17478.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3500.07,"maximum":16361.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6477.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6889.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16361.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13088.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9554.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4684.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16170.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.07},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5297.73,"maximum":18910.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7486.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7962.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18910.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15128.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11043.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5414.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18689.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5297.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5467.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14119.17,"maximum":54113.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21422.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22785.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54113.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43290.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31601.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15494.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53481.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.17},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15646.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5143.03,"maximum":19754.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7820.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8318.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19754.37},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15803.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11536.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5656.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19523.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6538.91,"maximum":25108.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9940.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10572.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25108.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20086.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14663.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24815.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6538.91},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7259.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11362.51,"maximum":43822.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17348.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18452.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43822.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35057.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25591.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12547.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43310.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.51},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5452.83,"10th_percentile":5452.83,"90th_percentile":5452.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22922.7,"maximum":98523.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39003.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41485.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":98523.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":78817.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57535.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28210.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97372.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22922.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27657.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28486.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31945.38,"maximum":152063.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64029.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":152063.02},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":121649.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88801.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43540.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":150287.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31945.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42686.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43967.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34251.55,"maximum":126172.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49949.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53128.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":126172.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":100937.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73682.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36127.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124699.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34251.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36481.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44477.45,"maximum":164094.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64961.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69095.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":164094.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":131274.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95827.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46985.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":162178.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44477.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46063.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47445.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50390.4,"maximum":194795.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77115.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82023.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":194795.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":155834.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113756.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55775.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":192520.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50390.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56322.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23210.61,"maximum":89925.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35599.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37865.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":89925.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":71940.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52514.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88875.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23210.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26000.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27910.31,"maximum":112704.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44617.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47456.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":112704.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":90162.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65816.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32270.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":111388.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27910.31},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31637.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32587.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17471.7,"maximum":69745.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27610.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29367.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":69745.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":55795.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40729.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19970.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68931.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17471.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19578.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20165.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5607.85,"maximum":20658.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8178.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8698.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20658.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16526.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12064.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5915.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20417.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5799.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7604.61,"maximum":28029.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11096.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11802.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28029.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22423.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16368.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27702.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7604.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12767.14,"maximum":45480.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18004.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19150.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45480.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36384.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26559.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44949.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13150.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5720.29,"maximum":21822.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8639.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9188.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21822.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17457.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12743.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6248.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21567.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5720.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6309.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":34845.27,"10th_percentile":34845.27,"90th_percentile":34845.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6238.1,"maximum":23614.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9348.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9943.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23614.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18891.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13790.38},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23338.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10147.84,"maximum":40123.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15883.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16894.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40123.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32098.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23431.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39654.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10147.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4923.88,"maximum":18697.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7401.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7872.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18697.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14957.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10918.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18478.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5406.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4681.93,"10th_percentile":4681.93,"90th_percentile":4681.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7279.46,"maximum":27600.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10926.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11621.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27600.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22080.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16118.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7902.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27278.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7279.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":7535.89,"10th_percentile":7535.89,"90th_percentile":7535.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":41911.11,"10th_percentile":41911.11,"90th_percentile":41911.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14345.49,"maximum":54938.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21748.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23133.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54938.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43950.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32082.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54297.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14345.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15884.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10648.46,"maximum":38350.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15182.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16148.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38350.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30680.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22395.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37902.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11088.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13405.12,"maximum":48004.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19004.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20213.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48004.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38403.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28033.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13745.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47444.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.12},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13475.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20073.65,"maximum":75321.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29818.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31715.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":75321.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":60256.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43985.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21566.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74441.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20073.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21778.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6427.18,"maximum":25128.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9947.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10580.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25128.02},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20102.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14674.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24834.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6427.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8502.73,"maximum":33900.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13420.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14274.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33900.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27119.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19796.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9706.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33504.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8502.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12375.22,"maximum":46701.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18488.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19664.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46701.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37361.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27272.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13372.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46156.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13503.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9763.24,"maximum":35394.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14011.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14903.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35394.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28315.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20669.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10134.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34981.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10233.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17145.83,"maximum":63464.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25124.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":63464.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":50771.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37062.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62723.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17145.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7686.26,"maximum":27854.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11026.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11728.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27854.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22283.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16266.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27529.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.26},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10553.21,"maximum":41713.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16513.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17564.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41713.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33370.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24359.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41226.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10553.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11709.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12060.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7045.98,"maximum":26750.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10590.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11264.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26750.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21400.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15621.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26438.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7734.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24753.3,"maximum":97154.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38461.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40909.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97154.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":77722.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56736.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96020.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24753.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27272.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28090.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36217.52,"maximum":144143.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57063.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60694.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":144143.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":115313.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84176.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":142460.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36217.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40463.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41677.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29783.89,"maximum":115373.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45673.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":115373.6},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":92298.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67375.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33034.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114026.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29783.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33358.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49093.36,"maximum":187897.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74384.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79118.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":187897.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":150316.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109727.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53800.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":185703.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49093.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52745.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54328.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34951.99,"maximum":130060.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51488.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54764.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":130060.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":104047.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75952.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37240.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128541.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34951.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37605.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44734.57,"maximum":167421.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66278.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70496.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":167421.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":133936.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97770.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47937.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":165466.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44734.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46997.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48407.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25311.22,"maximum":98845.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39130.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41621.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":98845.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":79075.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57723.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28302.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97691.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25311.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27747.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28579.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20234.08,"maximum":83525.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33065.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35170.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":83525.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":66819.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48776.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82549.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20234.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24150.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11783.64,"maximum":44527.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17627.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18749.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44527.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35621.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26002.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12749.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44007.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11783.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13477.45,"maximum":51646.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20445.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21747.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":51646.57},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41316.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30160.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14787.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51043.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13477.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14932.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23743.46,"maximum":88863.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35179.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37417.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88863.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":71089.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51894.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25444.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87825.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23743.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25693.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13368.59,"maximum":55241.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21869.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23260.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":55241.75},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":44193.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32259.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15817.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54596.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15972.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19398.99,"maximum":85839.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33981.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36144.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":85839.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":68670.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50128.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24578.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84836.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19398.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24096.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24819.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7097.54,"maximum":29837.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11812.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12563.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29837.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23870.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17424.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29489.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8627.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11743.53,"maximum":46384.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18362.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19531.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46384.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37107.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27087.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13281.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45843.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11743.53},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13411.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11540.34,"10th_percentile":11540.34,"90th_percentile":11540.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19676.88,"maximum":73690.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29172.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31029.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":73690.27},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":58951.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43033.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21099.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72829.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19676.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20686.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21306.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":26385.73,"10th_percentile":26385.73,"90th_percentile":26385.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12426.79,"maximum":48674.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19269.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20495.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48674.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38939.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28424.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13936.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48105.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.79},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14073.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18270.98,"maximum":70909.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28071.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29858.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":70909.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":56726.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41409.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20303.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70081.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18270.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20502.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24019.92,"maximum":95296.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37725.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40127.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":95296.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":76236.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55651.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27286.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94184.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24019.92},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27553.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11365.38,"maximum":40828.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16163.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17191.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40828.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32662.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23842.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40351.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11365.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16737.32,"maximum":59623.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23603.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25105.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59623.72},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47698.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34818.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17072.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58927.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16836.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17239.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32453.89,"maximum":124640.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49342.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52482.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":124640.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":99711.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72787.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35688.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123184.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32453.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34988.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36038.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13102.88,"maximum":49379.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19548.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20792.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49379.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39502.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28836.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48802.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13102.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13861.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16312.17,"maximum":58214.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23045.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24512.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":58214.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46570.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33995.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57534.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16312.17},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16831.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24485.18,"maximum":87224.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34530.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":87224.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":69778.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50936.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24974.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86205.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24745.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25219.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9983.83,"maximum":37820.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14972.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15925.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37820.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30256.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22086.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10829.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37378.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10935.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20119.49,"maximum":77872.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30828.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32790.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":77872.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":62297.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45476.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22297.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76963.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20119.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21860.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22515.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34426.3,"maximum":134455.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53228.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56615.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":134455.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":107563.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78519.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38498.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132885.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34426.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28943.07,"maximum":114433.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45301.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48185.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":114433.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":91546.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66826.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32765.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113097.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28943.07},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32123.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33087.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42116.86,"maximum":160324.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63468.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67508.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":160324.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":128258.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93625.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45905.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":158452.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42116.86},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37227.36,"maximum":149235.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59079.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62839.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":149235.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":119387.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87150.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42730.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147492.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37227.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41892.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43149.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55860.74,"maximum":208859.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82682.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87945.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":208859.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":167085.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121969.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59802.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":206420.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55860.74},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58630.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60388.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42603.87,"maximum":165624.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65567.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69739.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":165624.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":132498.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96720.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47423.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":163690.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42603.87},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47888.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58121.06,"maximum":230296.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91169.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96971.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":230296.44},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":184235.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134488.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65940.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":227607.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58121.06},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64647.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66587.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22772.3,"maximum":86041.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34061.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36229.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86041.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":68832.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50246.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24636.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85036.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22772.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24877.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36087.17,"maximum":135158.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53506.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56911.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":135158.02},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":108125.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78929.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38699.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":133579.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36087.17},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37940.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39079.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33293.27,"maximum":137693.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54509.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57978.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":137693.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":110153.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80409.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39425.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136085.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33293.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38652.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39812.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37561.83,"maximum":145686.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57674.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61344.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":145686.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":116548.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85077.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41714.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":143985.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37561.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42123.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55227.61,"maximum":209763.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83040.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88325.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":209763.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":167809.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122497.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60061.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":207314.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55227.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58883.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60650.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40799.77,"maximum":179630.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71111.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75637.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":179630.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":143703.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104900.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51433.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":177533.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40799.77},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51937.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45588.28,"maximum":179630.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71111.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75637.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":179630.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":143703.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104900.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51433.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":177533.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45588.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50425.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51937.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69509.36,"maximum":267256.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105800.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112534.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":267256.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":213803.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156071.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76523.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":264135.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69509.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75023.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77273.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73158.4,"maximum":272015.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107684.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114538.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":272015.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":217610.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158850.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77886.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":268839.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73158.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78649.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43765.49,"maximum":155906.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61720.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65648.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":155906.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":124724.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91046.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44640.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":154086.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43765.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45078.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77139.75,"maximum":297069.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117603.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125088.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":297069.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":237653.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173482.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85059.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":293600.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77139.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83392.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85893.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86802.44,"maximum":309218.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122412.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130203.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":309218.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":247372.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180576.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88538.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":305607.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89406.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19364.62,"maximum":75091.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29727.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31619.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":75091.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":60072.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43851.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21501.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74214.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19364.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21711.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":11354.4,"10th_percentile":11354.4,"90th_percentile":11354.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49346.9,"maximum":175789.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69591.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74020.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":175789.57},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":140630.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102657.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":173736.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49475.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49346.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50827.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6542.49,"maximum":25709.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10178.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10825.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25709.91},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20567.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15014.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7361.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25409.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6542.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12965.37,"maximum":50021.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19802.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21062.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50021.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40016.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29211.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49437.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12965.37},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14041.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14462.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5893.61,"maximum":22057.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8732.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22057.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17645.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12881.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6315.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21799.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6377.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4976.87,"maximum":18303.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7246.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7707.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18303.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14642.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10688.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5240.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18090.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.87},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5292.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6857.62,"maximum":26532.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10503.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11172.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26532.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21225.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15494.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7596.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26222.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":5064.79,"10th_percentile":5064.79,"90th_percentile":5064.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":24080.53,"10th_percentile":24080.53,"90th_percentile":24080.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5738.51,"10th_percentile":5738.51,"90th_percentile":5738.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5057.09,"maximum":19535.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7733.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8226.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19535.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15628.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11408.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19307.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5057.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5648.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":54860.38,"10th_percentile":54860.38,"90th_percentile":54860.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7713.47,"maximum":30031.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11888.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12645.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30031.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24025.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17537.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29681.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12706.1,"maximum":48193.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19078.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20292.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48193.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38554.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28143.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47630.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12706.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13934.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5492.45,"maximum":19565.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7745.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8238.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19565.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15652.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11426.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5602.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19337.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7144.1,"maximum":25928.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10264.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10917.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25928.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20742.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15141.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25625.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7496.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13574.85,"maximum":51556.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20410.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21709.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":51556.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41244.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30107.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14762.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50954.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13574.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14472.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14906.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4480.55,"maximum":17169.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6797.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7229.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17169.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13735.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10026.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4916.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16969.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4480.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4964.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":6538.35,"10th_percentile":6538.35,"90th_percentile":6538.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":20160.14,"10th_percentile":20160.14,"90th_percentile":20160.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5888.6,"maximum":22016.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8715.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9270.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22016.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17612.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12857.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6303.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21759.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5872.84,"10th_percentile":5872.84,"90th_percentile":5872.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9501.11,"maximum":35908.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14215.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35908.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28726.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20969.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10281.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35488.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9501.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10382.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":6538.35,"10th_percentile":6538.35,"90th_percentile":6538.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9005.22,"10th_percentile":9005.22,"90th_percentile":9005.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":24469.95,"10th_percentile":24469.95,"90th_percentile":24469.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8963.22,"10th_percentile":8963.22,"90th_percentile":8963.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7937.37,"10th_percentile":7937.37,"90th_percentile":9413.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4596.57,"maximum":17538.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6943.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17538.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14030.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10242.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5021.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17334.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4596.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5071.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13890.63,"maximum":49482.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19589.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20835.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49482.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39585.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28896.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48905.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13926.51},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13890.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14307.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12460.45,"maximum":47199.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18685.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19874.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47199.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37758.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27563.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13514.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46647.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12460.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13647.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15976.27,"maximum":60066.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23778.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25292.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":60066.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":48052.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35077.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59364.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15976.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16861.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17367.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27577.28,"maximum":105484.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41758.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44416.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":105484.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":84386.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61600.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30203.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104252.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27577.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29611.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30499.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8171.84,"maximum":32113.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12713.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13522.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32113.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25690.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18753.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9195.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31738.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9285.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11458.48,"maximum":44327.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17548.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18665.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44327.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35461.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25886.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43810.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11458.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24176.05,"maximum":89936.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35604.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37870.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":89936.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":71948.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52521.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88886.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24176.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26004.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12950.33,"maximum":53075.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21011.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22348.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53075.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42459.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30994.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52455.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.33},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15346.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16469.02,"maximum":65306.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25853.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27498.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65306.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52244.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38137.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64543.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16469.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18332.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27941.83,"maximum":105743.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41861.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":105743.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":84594.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61751.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104508.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27941.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30574.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11623.21,"maximum":45428.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17984.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19128.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45428.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36342.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26529.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13007.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44898.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15425.52,"maximum":58216.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23046.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24513.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":58216.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46573.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33997.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57537.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29483.09,"maximum":122402.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48456.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51540.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":122402.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":97921.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71480.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120973.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29483.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34360.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35391.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16608.68,"maximum":59970.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23741.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59970.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47976.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35021.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59270.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17339.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24552.77,"maximum":93201.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36896.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39244.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":93201.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":74560.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54427.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26686.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92113.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24552.77},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26948.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43158.93,"maximum":164140.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64979.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69115.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":164140.75},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":131311.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95854.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46998.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":162224.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43158.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46076.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47459.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17424.43,"maximum":68923.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27285.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29021.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":68923.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":55137.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40249.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19734.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68118.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17424.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19928.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21150.1,"maximum":84940.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33626.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35766.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":84940.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":67951.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49603.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24320.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83948.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24559.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31627.39,"maximum":124211.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49172.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52302.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":124211.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":99368.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72536.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35565.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":122760.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31627.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34868.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35914.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27135.39,"maximum":106869.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42307.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44999.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":106869.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":85494.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62409.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30599.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105621.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27135.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30899.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40599.95,"maximum":156546.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61973.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65917.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":156546.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":125235.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91419.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44823.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":154718.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40599.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43944.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45263.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24367.08,"maximum":86803.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34363.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36550.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86803.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":69442.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50691.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24854.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85789.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28094.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25098.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40597.48,"maximum":144621.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57252.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":144621.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":115696.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84455.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":142932.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43984.71},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41815.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60344.83,"maximum":214967.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85101.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90517.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":214967.75},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":171972.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125536.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61551.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":212457.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60536.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62155.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54714.34,"maximum":194910.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77160.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82071.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":194910.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":155926.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113823.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55808.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":192634.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57249.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54714.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56355.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":263867.42,"maximum":1179710.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":467021.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":496745.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":1179710.91},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":943760.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":688925.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337786.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1165935.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263867.42},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331163.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":341098.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41659.62,"maximum":148405.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58750.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62489.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":148405.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":118722.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86665.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42492.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":146672.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44239.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44239.67,"maximum":161993.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64129.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68211.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":161993.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":129593.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94600.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46383.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":160101.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44239.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45474.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46838.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6080.54,"maximum":23029.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9117.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9697.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23029.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18423.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13448.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22761.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6658.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5209.55,"10th_percentile":5209.55,"90th_percentile":5209.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7892.52,"maximum":30261.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11979.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30261.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24208.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17671.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8664.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29907.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7892.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8749.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7280.0,"10th_percentile":7280.0,"90th_percentile":7280.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8823.58,"maximum":33749.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13360.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14211.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33749.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26999.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19709.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33355.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":12992.7,"10th_percentile":12992.7,"90th_percentile":12992.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5878.93,"10th_percentile":5878.93,"90th_percentile":5878.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":38173.88,"10th_percentile":38173.88,"90th_percentile":65717.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8432.6,"10th_percentile":8432.6,"90th_percentile":8432.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5346.43,"maximum":19593.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7756.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8250.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19593.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15674.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11441.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19364.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5346.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5665.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7135.5,"maximum":27021.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10697.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11377.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27021.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21616.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15779.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26705.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11116.14,"maximum":42576.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16855.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17927.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42576.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34061.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24863.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42079.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11116.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5412.32,"maximum":21486.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8506.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9047.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21486.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17188.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12547.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21235.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5412.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7533.71,"maximum":29070.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12240.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29070.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23255.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16976.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8323.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28730.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.71},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11276.57,"maximum":41795.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16545.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17598.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41795.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33435.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24407.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41307.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5721.01,"maximum":20593.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8152.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8671.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20593.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16474.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12025.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20352.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5721.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5780.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7886.08,"maximum":29258.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11582.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12320.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29258.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23406.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17086.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28917.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12448.99,"maximum":48245.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19099.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20314.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48245.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38595.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28174.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47682.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11917.63,"10th_percentile":11917.63,"90th_percentile":11917.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5466.75,"maximum":20625.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8165.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20625.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16500.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12045.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5905.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20385.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5466.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5963.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7066.75,"maximum":26663.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10555.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11227.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26663.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21330.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15570.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26352.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7066.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11984.15,"maximum":42691.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16900.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17976.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42691.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34152.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24930.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42192.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12149.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12343.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6151.8,"10th_percentile":6151.8,"90th_percentile":6151.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5841.33,"maximum":21991.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8706.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9260.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21991.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17593.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12842.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21735.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5841.33},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.29,"maximum":37525.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14855.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15800.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37525.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30020.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21914.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10744.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37087.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9602.94,"10th_percentile":9602.94,"90th_percentile":9602.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22023.15,"maximum":81312.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32189.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34238.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":81312.27},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":65049.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47484.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23282.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80362.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22023.15},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23510.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9709.52,"maximum":37328.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14777.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15718.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37328.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29862.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21799.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10688.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36892.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10478.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10793.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13033.41,"maximum":49267.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19503.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20745.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49267.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39413.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28770.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14106.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48691.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13033.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13830.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28663.95,"maximum":102110.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40423.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":102110.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":81687.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59630.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100917.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29061.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29523.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13438.78,"maximum":52294.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20702.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22019.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52294.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41834.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30538.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51683.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18265.96,"maximum":68953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27297.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29034.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":68953.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":55162.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40267.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19743.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68148.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18265.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19936.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33758.8,"maximum":122438.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48470.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51555.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":122438.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":97949.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71501.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35057.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121008.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33758.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34370.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35401.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4835.78,"maximum":19355.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7662.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8150.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19355.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15484.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11303.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5542.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19129.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4835.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5596.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6721.54,"maximum":24854.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9839.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10465.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24854.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19883.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14514.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24564.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12225.53,"maximum":46901.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18567.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19748.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46901.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37520.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27389.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13429.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46353.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.53},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13560.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4694.69,"maximum":18880.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7474.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7949.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18880.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15103.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11025.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18659.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4694.69},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5458.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6779.55,"maximum":25037.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9911.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10542.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25037.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20030.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14621.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24745.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11016.59,"maximum":42713.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16909.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42713.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34170.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24943.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12230.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42214.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11016.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12349.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5262.64,"maximum":20166.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7983.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8491.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20166.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16133.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11777.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19931.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5262.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8509.89,"maximum":32296.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12785.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13599.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32296.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25836.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18860.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31919.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8509.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9338.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82082.97,"maximum":328317.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129973.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":138245.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":328317.01},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":262651.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191729.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94007.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":324483.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82082.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92163.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94928.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19234.98,"maximum":78727.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31166.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":78727.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":62981.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45975.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22542.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77808.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19234.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22763.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28683.09,"maximum":115176.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45596.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48497.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":115176.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":92140.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67260.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32978.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113832.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28683.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33301.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36929.42,"maximum":149000.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58986.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62740.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":149000.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":119199.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87013.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42663.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147260.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36929.42},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41826.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43081.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34475.0,"maximum":196032.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77605.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82544.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":196032.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":156824.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114478.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56130.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":193743.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34475.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56680.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37684.3,"maximum":153112.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60613.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64471.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":153112.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":122488.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89414.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43840.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151324.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37684.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44270.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87851.96,"maximum":353786.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140056.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148970.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":353786.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":283026.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206603.61},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101299.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":349655.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87851.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102292.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34641.88,"maximum":126678.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50149.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53340.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":126678.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":101341.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73977.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36271.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125199.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34641.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35560.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36627.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74126.7,"maximum":281672.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111508.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118604.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":281672.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":225335.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164490.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80651.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":278383.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74126.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79069.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81442.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":105281.4,"maximum":378406.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149802.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":159336.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":378406.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":302722.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220981.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108349.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":373987.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105281.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106224.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109411.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":152695.99,"maximum":579851.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229550.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":244160.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":579851.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":463876.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":338620.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166028.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":573080.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152695.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167656.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86902.14,"maximum":309573.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122553.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130353.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":309573.44},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":247656.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180784.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88640.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":305958.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87692.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86902.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89509.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":194080.17,"maximum":765584.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303078.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":322367.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":765584.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":612462.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":447084.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219209.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":756645.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194080.17},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221359.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5519.75,"maximum":20052.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7938.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8443.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20052.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16041.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11710.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5741.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19818.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5797.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":19907.62,"10th_percentile":19907.62,"90th_percentile":19907.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4393.36,"10th_percentile":4393.36,"90th_percentile":4393.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9414.45,"maximum":36375.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14400.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15316.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36375.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29099.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21242.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10415.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35950.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9414.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5333.54,"maximum":20532.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8128.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8645.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20532.96},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16426.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11990.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5879.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20293.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6112.86,"maximum":21775.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8620.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9169.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21775.97},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17420.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12716.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21521.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6372.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8850.8,"maximum":34736.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13751.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14626.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":34736.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27788.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20285.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34330.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8850.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10043.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15118.98,"maximum":57845.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22899.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24357.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57845.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46275.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33780.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16562.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57169.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8745.52,"maximum":32845.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13002.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13830.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32845.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26276.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19181.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9404.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32462.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9496.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":17281.32,"10th_percentile":17281.32,"90th_percentile":26566.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12393.84,"maximum":47341.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18741.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19934.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47341.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37872.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27646.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13555.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46788.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12393.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22823.04,"10th_percentile":22823.04,"90th_percentile":22823.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23817.95,"maximum":102353.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40519.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43098.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":102353.37},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":81881.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59772.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29306.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101158.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23817.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29594.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11065.29,"maximum":43612.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17265.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18363.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43612.05},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34889.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25468.49},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43102.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11065.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12609.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14837.52,"maximum":59585.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23588.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25089.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59585.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47667.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34796.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58889.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14837.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17228.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27058.75,"maximum":116523.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46129.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49065.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":116523.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":93218.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68047.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33364.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115163.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27058.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32710.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33691.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8506.31,"maximum":33758.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13364.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14214.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33758.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27006.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19713.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9665.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33363.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8506.31},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9760.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6200.14,"maximum":24210.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9584.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10194.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24210.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19367.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14138.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23927.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6200.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7000.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10776.66,"maximum":40792.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16148.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17176.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40792.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32633.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23822.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40316.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.66},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.28,"maximum":27736.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10980.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11679.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27736.98},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22189.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16197.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7941.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27413.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16641.45,"maximum":59282.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23468.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24962.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59282.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47425.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34619.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16974.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58590.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17140.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5711.7,"maximum":20975.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8303.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8832.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20975.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16780.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12249.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6005.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20730.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12545.69,"10th_percentile":12545.69,"90th_percentile":12545.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9467.45,"maximum":36145.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14309.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15220.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36145.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28916.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21108.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35723.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9467.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5758.25,"maximum":21816.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8636.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9186.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21816.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17453.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12740.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21562.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5758.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6308.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5323.44,"10th_percentile":5323.44,"90th_percentile":5323.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5332.11,"maximum":21467.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8498.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9039.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21467.27},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17173.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12536.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21216.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5332.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8921.2,"maximum":31780.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12581.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13381.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31780.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25423.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18558.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9099.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31409.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9175.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8319.96,"maximum":29638.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11733.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12479.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29638.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23710.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17308.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29292.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8582.94},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8569.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13112.19,"maximum":49395.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19554.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49395.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39516.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28845.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14143.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48818.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13112.19},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14282.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11204.23,"maximum":41931.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16599.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17656.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41931.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33545.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24487.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41442.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12124.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8822.15,"maximum":36962.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14632.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15563.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36962.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29569.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21585.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10583.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36531.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.15},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17957.28,"maximum":64229.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25427.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27045.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":64229.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":51383.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37508.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63479.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18571.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6033.27,"maximum":22846.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9044.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9620.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22846.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18277.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13342.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22580.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":28034.39,"10th_percentile":28034.39,"90th_percentile":28034.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8596.04,"maximum":30621.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12122.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12894.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30621.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24497.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17882.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30264.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8853.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6514.56,"maximum":24658.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9761.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10382.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24658.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19726.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14399.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7060.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24370.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14198.67,"maximum":52911.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20946.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22279.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52911.44},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42328.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30899.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15150.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52293.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14198.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9455.27,"maximum":37219.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14734.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15672.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37219.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29775.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21735.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36784.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10448.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10761.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15430.53,"maximum":62694.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24819.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26398.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":62694.37},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":50155.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36612.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61962.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15430.53},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18127.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26047.48,"maximum":98670.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39061.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41547.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":98670.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":78935.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57621.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28252.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97518.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26047.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27698.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28529.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15611.01,"maximum":70461.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27894.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29669.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":70461.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":56368.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41147.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20175.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69638.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15611.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17075.64,"maximum":70461.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27894.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29669.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":70461.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":56368.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41147.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20175.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69638.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17075.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25945.78,"maximum":96146.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38062.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40484.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":96146.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":76916.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56147.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95023.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25945.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27799.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5546.25,"maximum":21754.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8611.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9160.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21754.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17403.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12703.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21500.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5546.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6289.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7348.93,"maximum":27947.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11063.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11767.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27947.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22357.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16320.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27621.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":28859.79,"10th_percentile":28859.79,"90th_percentile":28859.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12814.25,"maximum":47977.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18993.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20202.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47977.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38381.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28017.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47417.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6313.02,"maximum":22489.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8902.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9469.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22489.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17991.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13133.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6439.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22226.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6695.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8235.58,"maximum":30012.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11881.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12637.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30012.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24009.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17526.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29662.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8235.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8677.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10366.78,"maximum":36929.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14619.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15550.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36929.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29543.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21566.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10574.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36498.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10985.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6346.96,"maximum":24988.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9892.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10522.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24988.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19990.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14592.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24696.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6346.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7225.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9433.07,"maximum":35588.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14088.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14985.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35588.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28470.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20782.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10190.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35172.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.07},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16277.79,"maximum":62066.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24570.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26134.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":62066.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":49652.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36245.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61341.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16277.79},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17945.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6586.89,"maximum":26111.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10336.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10994.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26111.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20889.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15248.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25806.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6586.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9714.54,"maximum":38131.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15095.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16056.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38131.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30505.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22268.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37686.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11025.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16317.18,"maximum":62440.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24718.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26291.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":62440.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":49951.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36463.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17878.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61711.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16317.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18053.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6513.84,"maximum":24466.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9685.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10302.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24466.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19573.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14288.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7005.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24181.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7074.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13880.66,"maximum":49447.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19575.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20820.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49447.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39557.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28876.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14158.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48870.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15818.71},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14297.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6328.35,"maximum":22543.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8924.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9492.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22543.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18034.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13164.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22280.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13706.64,"maximum":52384.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20737.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22057.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52384.18},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41906.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30591.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14999.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51772.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7349.64,"maximum":28160.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11148.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11857.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28160.43},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22528.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16445.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27831.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":22382.74,"10th_percentile":22382.74,"90th_percentile":22382.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10836.11,"maximum":43827.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17350.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18454.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43827.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35061.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25594.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43316.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10836.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10013.91,"maximum":37719.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14932.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15882.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37719.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30175.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22027.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37278.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10013.91},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10588.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10906.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6271.76,"maximum":23352.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9244.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9833.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23352.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18681.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13637.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23079.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.76},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11222.14,"maximum":43226.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17112.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18201.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43226.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34581.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25243.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12377.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42722.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11222.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6958.6,"maximum":26671.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10558.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11230.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26671.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21337.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15575.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7636.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26360.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7711.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":15399.27,"10th_percentile":15399.27,"90th_percentile":15399.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4899.52,"maximum":18612.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7368.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7837.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18612.43},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14889.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10869.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18395.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4899.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5381.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10409.97,"maximum":40344.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15971.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40344.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32275.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23560.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11551.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39873.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10409.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11665.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5703.82,"maximum":21576.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8541.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21576.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17261.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12600.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21324.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.82},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3582.56,"10th_percentile":3582.56,"90th_percentile":3582.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4003.56,"maximum":14861.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5883.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6257.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":14861.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":11889.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8678.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4255.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14688.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4003.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4297.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":2907.6,"10th_percentile":2907.6,"90th_percentile":2907.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9136.56,"maximum":34648.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13716.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14589.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":34648.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27718.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20234.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9920.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34244.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9136.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7690.6,"10th_percentile":7690.6,"90th_percentile":7690.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5626.47,"maximum":21297.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8431.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8967.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21297.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17038.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12437.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6098.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21049.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6158.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":22632.11,"10th_percentile":22632.11,"90th_percentile":22632.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":33123.6,"10th_percentile":20061.0,"90th_percentile":33316.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11599.58,"maximum":43691.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17296.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18397.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43691.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34952.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25514.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12510.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43181.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6710.08,"maximum":25562.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10119.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10763.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25562.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20449.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14927.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25263.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6710.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4637.4,"maximum":17730.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7018.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7465.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17730.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14183.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10353.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17523.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4637.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4977.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5126.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":24971.29,"10th_percentile":24971.29,"90th_percentile":24971.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16090.15,"maximum":65426.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25900.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27549.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65426.27},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52340.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38207.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64662.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.15},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18917.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10838.25,"maximum":41350.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16369.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17411.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41350.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33079.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24147.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40867.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10838.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11955.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7972.02,"maximum":31272.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12379.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13167.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31272.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25017.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18262.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30906.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9041.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30832.7,"maximum":109836.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43481.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46249.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":109836.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":87868.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64141.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31449.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108553.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31757.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39428.24,"maximum":149448.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59163.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62928.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":149448.59},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":119557.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87274.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42791.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147703.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39428.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43211.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20679.56,"maximum":79230.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31365.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33361.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":79230.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63383.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46268.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22686.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78305.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20679.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22908.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15405.46,"maximum":60637.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24004.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25532.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":60637.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":48509.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35410.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17362.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59929.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15405.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17532.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14018.18,"maximum":59481.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23547.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59481.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47584.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34735.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17031.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58787.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14018.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25247.48,"maximum":97326.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38529.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40981.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97326.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":77860.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56836.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27867.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96190.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25247.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27321.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28140.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16600.08,"maximum":65194.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25808.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27451.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":65194.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":52154.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38071.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18667.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64432.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16600.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11707.72,"maximum":46212.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18294.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19459.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46212.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36969.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26987.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45673.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.72},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13361.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11292.72,"10th_percentile":11292.72,"90th_percentile":11292.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9405.14,"maximum":37312.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14771.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15711.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37312.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29849.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21789.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36876.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10788.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":39098.16,"10th_percentile":39098.16,"90th_percentile":48978.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":2727.51,"10th_percentile":2727.51,"90th_percentile":2727.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22924.13,"maximum":93078.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36847.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39192.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":93078.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":74462.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54355.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26651.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91991.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22924.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26128.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26912.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12244.16,"maximum":47466.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18791.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19987.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47466.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37973.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27719.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46912.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10105.58,"maximum":38232.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15135.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16098.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38232.94},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30586.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22327.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37786.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28009.87,"maximum":113455.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44914.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47773.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":113455.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":90763.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66255.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32485.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112131.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28009.87},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31848.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32804.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15267.24,"maximum":59771.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23662.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25168.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59771.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47816.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34905.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17114.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59073.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15267.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17282.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11472.81,"maximum":40986.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16225.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17258.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40986.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32789.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23935.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11735.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40508.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11850.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":84520.19,"maximum":301088.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119194.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126780.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":301088.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":240868.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175828.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86210.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":297572.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84520.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87055.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55358.53,"maximum":197204.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78069.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83037.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":197204.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":157762.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115163.38},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56465.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":194902.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57019.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43114.41,"maximum":153587.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60801.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64671.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":153587.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":122868.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89691.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43976.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151794.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43114.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44407.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69093.48,"maximum":246133.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97438.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":246133.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":196904.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143736.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70475.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":243259.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69093.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71166.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44227.16,"maximum":157551.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62371.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66340.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":157551.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":126039.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92006.58},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45111.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":155711.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45553.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13722.39,"maximum":53769.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21286.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22640.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53769.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43015.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31400.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15395.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53141.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15093.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15546.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7384.02,"maximum":28854.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11422.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12149.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28854.33},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23083.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16850.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8261.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28517.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7384.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4794.96,"maximum":19464.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7705.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8196.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19464.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15571.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11367.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19237.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4794.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5627.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12604.4,"maximum":50176.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19863.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21128.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50176.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40141.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29302.16},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14367.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49590.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14507.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7883.21,"maximum":30900.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12232.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13011.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30900.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24720.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18045.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8847.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30539.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8934.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5952.34,"maximum":23311.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9228.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9815.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23311.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18648.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13613.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23039.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6740.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11951.95,"maximum":44535.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17630.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18752.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44535.43},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35628.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26007.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12751.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44015.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6124.94,"maximum":22980.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9097.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9676.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22980.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18384.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13420.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6580.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22712.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.94},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":3197.0,"10th_percentile":3197.0,"90th_percentile":3197.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4408.93,"maximum":16976.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6720.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7148.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16976.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13580.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9913.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4860.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16777.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4408.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4908.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":19271.73,"10th_percentile":19271.73,"90th_percentile":19271.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":70017.32,"10th_percentile":70017.32,"90th_percentile":70017.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13093.57,"maximum":49029.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19409.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20645.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49029.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39223.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28632.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14038.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48456.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13093.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14176.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.64,"maximum":26371.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10439.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11104.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26371.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21096.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15400.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7550.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26063.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5118.68,"maximum":19115.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7567.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8048.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19115.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15291.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11162.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5473.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18891.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5365.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11696.98,"maximum":45647.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18070.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45647.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36517.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26657.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13070.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45114.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13198.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6564.55,"10th_percentile":6564.55,"90th_percentile":6564.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7783.66,"maximum":29897.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11835.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12589.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29897.91},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23918.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17459.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29548.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.66},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4847.22,"10th_percentile":4847.22,"90th_percentile":4847.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":24452.57,"10th_percentile":24452.57,"90th_percentile":24452.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":12130.32,"10th_percentile":12130.32,"90th_percentile":12130.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5740.34,"maximum":22601.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8947.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9516.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22601.01},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18080.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13198.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22337.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5740.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":6894.0,"10th_percentile":6894.0,"90th_percentile":6894.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51240.34,"maximum":182534.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72261.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76860.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":182534.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":146026.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106596.24},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52265.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":180403.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51240.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52777.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32522.16,"maximum":115854.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45864.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48783.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":115854.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":92682.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67656.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33172.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114501.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32522.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33497.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40872.03,"maximum":145599.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57639.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61308.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":145599.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":116478.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85026.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41689.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":143899.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42098.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24773.53,"maximum":88251.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34936.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37160.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88251.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70600.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51536.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25269.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87220.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25516.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60371.36,"maximum":229572.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90882.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96666.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":229572.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":183656.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134065.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65733.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":226891.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60371.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66377.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43511.3,"maximum":162905.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64490.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68595.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":162905.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":130323.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95133.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46644.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":161003.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43511.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47102.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31999.14,"maximum":113991.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45126.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47998.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":113991.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":91192.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66568.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32639.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112660.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32451.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31999.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32959.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42355.19,"maximum":150882.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59731.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63532.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":150882.84},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":120705.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88112.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43202.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":149121.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48834.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42355.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43625.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20385.2,"maximum":72668.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28767.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30598.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":72668.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":58134.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42436.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71820.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20385.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20399.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21011.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40563.42,"maximum":155704.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61640.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":155704.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":124562.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90928.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44582.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153886.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40563.42},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43708.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45020.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21496.03,"maximum":85090.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33685.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35829.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":85090.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":68071.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49690.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24363.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84096.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21496.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23886.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24602.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13398.67,"maximum":49821.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19723.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20978.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49821.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39856.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29094.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14265.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49239.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13398.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14405.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37146.43,"maximum":142206.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56296.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59879.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":142206.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":113764.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83045.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40717.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140545.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37146.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41117.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24968.88,"maximum":96343.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38140.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40567.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":96343.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":77073.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56262.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95218.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24968.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27856.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19119.68,"maximum":75072.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29719.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31611.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":75072.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":60057.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43840.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21495.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74196.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19119.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21706.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23261.23,"maximum":82863.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32804.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34891.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":82863.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":66290.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48390.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23726.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81896.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23848.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23959.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13476.74,"maximum":52695.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20861.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52695.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42156.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30773.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15088.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52080.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13476.74},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14792.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15236.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5738.12,"10th_percentile":5738.12,"90th_percentile":5738.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":73952.93,"10th_percentile":73952.93,"90th_percentile":73952.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14627.72,"10th_percentile":14627.72,"90th_percentile":14627.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13223.02,"10th_percentile":13223.02,"90th_percentile":13223.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35229.88,"maximum":131915.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52222.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55546.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":131915.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":105531.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77035.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37771.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130374.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35229.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38141.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21166.57,"maximum":80484.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31862.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33889.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":80484.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":64387.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47001.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79544.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21166.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23271.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17622.82,"maximum":66693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26402.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28083.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":66693.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":53354.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38947.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19096.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65915.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17622.82},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19283.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30816.65,"maximum":117277.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46427.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49382.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":117277.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":93821.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68487.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33580.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115908.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30816.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32921.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33909.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15360.34,"maximum":62169.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24611.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26178.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":62169.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":49735.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36305.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17801.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61443.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15360.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":16650.0,"10th_percentile":16650.0,"90th_percentile":16650.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8428.96,"maximum":32241.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12763.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13576.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32241.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25793.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18828.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9231.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31865.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9322.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24128.78,"maximum":94376.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37361.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39739.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":94376.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":75500.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55113.65},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27022.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93274.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24128.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26492.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27287.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17072.06,"maximum":67182.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26596.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28288.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":67182.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":53745.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39233.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19236.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66398.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17072.06},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18859.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19425.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16479.05,"10th_percentile":16479.05,"90th_percentile":16479.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13349.97,"maximum":50783.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20104.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21383.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50783.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40626.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29656.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14540.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50190.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14255.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21120.02,"maximum":79561.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31496.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33501.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":79561.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63648.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46461.96},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22780.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78632.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21120.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23004.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14113.82,"10th_percentile":14113.82,"90th_percentile":14113.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14860.43,"maximum":57219.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22652.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24093.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57219.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45775.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33415.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16383.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56551.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14860.43},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16544.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11376.12,"maximum":44557.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17639.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44557.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35645.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26020.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44037.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.12},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12883.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17791.84,"maximum":75725.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29978.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31886.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":75725.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":60579.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44222.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21682.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74841.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17791.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21895.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23591.63,"maximum":88161.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34901.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37122.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88161.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70528.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51484.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87131.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23591.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25490.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14383.44,"maximum":57126.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22615.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24054.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57126.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45700.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33360.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16357.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56459.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.44},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16036.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16517.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11064.57,"maximum":42787.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16938.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18016.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42787.02},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34229.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24986.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12251.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42287.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11064.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12371.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13565.47,"maximum":48324.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19130.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20348.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48324.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38659.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28220.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13836.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47760.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13565.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13972.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8564.6,"maximum":30509.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12078.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12846.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30509.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24407.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17817.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30153.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8864.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24795.56,"maximum":100304.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39708.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42235.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":100304.44},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":80242.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58575.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99133.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24795.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29001.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17200.98,"maximum":69283.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27427.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29173.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":69283.72},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":55426.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40460.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19838.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68474.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17200.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19449.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20032.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":242724.34,"10th_percentile":242724.34,"90th_percentile":242724.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13387.21,"maximum":54815.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21700.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23081.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54815.57},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43852.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32011.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54175.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15849.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25648.55,"maximum":99050.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39211.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41707.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":99050.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":79239.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57843.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28361.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97893.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25648.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28639.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13833.88,"maximum":49280.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19509.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20750.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49280.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39424.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28778.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48705.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14234.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9266.3,"maximum":33009.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13067.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13899.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33009.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26407.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19276.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9451.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32624.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10223.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18699.98,"maximum":82415.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32626.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34703.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":82415.96},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":65932.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48129.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23598.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81453.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23829.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9237.55,"maximum":55042.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21790.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23176.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":55042.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":44033.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32143.51},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15760.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54399.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15914.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23224.93,"maximum":86459.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34227.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36405.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86459.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":69166.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50490.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24755.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85449.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23224.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24270.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24998.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12431.08,"maximum":47756.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18905.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20108.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47756.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38204.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27888.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13674.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47198.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13405.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13808.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27098.78,"10th_percentile":27098.78,"90th_percentile":27098.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9902.9,"maximum":36768.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14555.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15482.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36768.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29414.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21472.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10527.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36339.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10631.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19207.77,"maximum":76250.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30185.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32106.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":76250.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":60999.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44528.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21832.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75359.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19207.77},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22046.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12369.49,"maximum":51064.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20215.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21501.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":51064.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40851.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29820.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14621.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50468.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12369.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14334.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14764.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12216.22,"maximum":48977.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19389.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20623.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48977.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39181.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28601.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14023.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48405.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12216.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14161.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10346.84,"maximum":36858.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14591.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15520.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36858.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29486.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21524.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10553.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36428.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10475.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13853.05,"maximum":49349.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19536.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20779.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49349.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39478.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28818.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14130.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48772.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15267.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10270.31,"maximum":41371.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16378.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17420.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41371.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33097.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24160.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11846.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40888.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.31},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11613.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11962.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19484.94,"maximum":82517.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32666.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34745.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":82517.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":66013.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48188.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23627.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81553.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19484.94},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23858.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14279.6,"maximum":56807.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22488.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23919.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56807.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45445.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33174.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56143.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16425.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11558.04,"maximum":45223.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17903.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19042.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45223.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36178.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26409.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12948.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44695.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11609.6,"maximum":43008.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17026.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18109.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43008.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34406.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25115.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12314.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42506.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11609.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12435.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7459.22,"maximum":27928.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11056.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11759.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27928.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22342.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16309.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27602.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7459.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8075.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10702.89,"maximum":41981.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16619.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17677.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41981.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33584.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24516.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41490.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10702.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12138.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26154.19,"maximum":102099.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40418.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42991.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":102099.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":81678.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59623.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100907.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.19},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28660.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29520.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14099.11,"maximum":54643.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21632.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54643.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43714.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31910.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15646.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54005.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14099.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15339.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15799.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10252.4,"maximum":40811.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16156.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17184.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40811.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32649.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23833.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11685.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40335.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11800.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21444.46,"maximum":78410.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31041.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":78410.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":62728.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45790.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77495.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21444.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22671.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15127.58,"maximum":57853.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22902.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24360.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57853.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46282.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33785.15},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57177.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15127.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11684.09,"maximum":42828.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16954.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18033.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42828.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34262.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25010.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12262.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42327.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12383.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5801.22,"maximum":22021.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8717.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9272.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22021.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17617.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12860.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6305.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21764.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9286.97,"maximum":35022.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13864.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14747.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35022.96},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28018.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20452.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34614.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10126.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5637.21,"maximum":22062.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8734.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9290.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22062.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17650.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12884.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6317.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21805.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5637.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6925.65,"maximum":26070.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10320.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10977.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26070.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20856.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15224.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25766.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6925.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5078.57,"maximum":19677.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7790.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8285.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19677.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15742.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11491.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5634.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19448.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5078.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5689.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14212.27,"maximum":53810.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21302.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22658.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53810.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43047.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31424.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15407.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53181.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15558.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9297.71,"maximum":35413.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14019.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35413.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28330.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20680.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10139.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35000.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.71},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10239.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6038.47,"maximum":21510.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8515.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9057.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21510.98},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17208.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12561.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6159.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21259.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13061.34,"maximum":48259.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19104.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20320.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":48259.01},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38606.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28182.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47695.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13547.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13953.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7811.59,"maximum":28083.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11117.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11825.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28083.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22466.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16400.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8041.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27756.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7811.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8120.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5496.84,"maximum":20614.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8161.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8680.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20614.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16491.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.66},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5902.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20374.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5496.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5960.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17856.3,"maximum":67797.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26839.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28547.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":67797.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":54237.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39592.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19412.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67005.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17856.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19031.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8589.39,"maximum":31509.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12474.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13267.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31509.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25207.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18401.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31141.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9110.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5896.47,"maximum":22844.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9043.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9619.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22844.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18275.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13340.48},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6540.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22577.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13964.47,"maximum":52750.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20882.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22211.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52750.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42199.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30805.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52134.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.47},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15252.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8638.8,"maximum":32979.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13055.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13886.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32979.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26383.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19259.31},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9443.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32594.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8638.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6703.36,"maximum":23879.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9453.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10055.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23879.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19103.46},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13945.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6837.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23600.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6757.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6904.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12189.01,"maximum":45789.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18127.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19280.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45789.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36631.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26740.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13110.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45254.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13239.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6920.64,"maximum":26261.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10396.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11058.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26261.75},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21009.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15336.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25955.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7593.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6555.94,"10th_percentile":6555.94,"90th_percentile":6555.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":16665.01,"10th_percentile":16665.01,"90th_percentile":16665.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9679.44,"maximum":35413.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14019.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35413.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28330.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20680.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10139.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35000.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9679.44},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10239.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5885.73,"maximum":22677.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8977.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9548.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22677.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18141.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13243.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6493.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22412.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5885.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6556.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10019.64,"maximum":36110.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14295.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15205.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36110.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28887.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21087.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10339.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35688.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5904.35,"maximum":22691.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8982.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9554.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22691.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18152.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13251.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6497.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22426.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6560.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11149.8,"maximum":40620.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16080.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17104.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40620.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32496.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23721.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11630.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40146.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6291.1,"maximum":24401.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9659.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24401.33},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19520.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14249.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6986.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24116.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6291.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13253.28,"maximum":50947.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20168.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50947.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40757.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29752.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50352.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.28},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14301.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8108.1,"maximum":30763.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12178.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12953.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30763.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24610.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17965.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30404.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5587.79,"maximum":21961.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8694.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9247.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21961.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17569.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12825.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6288.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21705.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5587.79},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6349.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10891.25,"maximum":38924.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15409.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16389.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38924.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31139.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22730.83},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11145.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38469.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10891.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6414.29,"maximum":24464.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9684.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10301.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24464.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19571.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14286.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24178.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6414.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7073.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11186.33,"maximum":42169.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16694.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17756.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42169.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33735.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24626.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41677.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11186.33},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7157.7,"maximum":26619.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10538.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26619.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21295.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15545.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26308.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7157.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5375.08,"maximum":20470.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8103.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8619.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20470.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16375.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11954.11},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20231.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5375.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5746.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5918.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20928.8,"maximum":80347.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31808.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33832.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":80347.91},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":64277.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46921.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23006.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79409.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20928.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22554.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23231.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12117.39,"maximum":46155.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18271.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19434.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46155.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36924.02},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26953.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13215.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45616.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":16170.75,"10th_percentile":16170.75,"90th_percentile":16170.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":52798.25,"10th_percentile":52798.25,"90th_percentile":52798.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8161.82,"maximum":31315.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12397.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13186.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31315.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25052.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18287.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30950.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8161.82},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44534.03,"maximum":178977.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70853.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75362.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":178977.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":143180.85},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104519.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51246.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":176887.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44534.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51749.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24392.34,"maximum":94835.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37543.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39932.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":94835.18},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":75867.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55381.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27154.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93727.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24392.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27420.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13780.97,"maximum":49092.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19434.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20671.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49092.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39273.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28668.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14056.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48519.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14653.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14194.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37586.68,"maximum":133895.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53006.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56380.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":133895.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":107115.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78192.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38338.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132332.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40702.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38714.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18972.85,"maximum":72414.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28667.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30491.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":72414.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":57931.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42288.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20734.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71568.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18972.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20937.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11534.4,"maximum":43885.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17373.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18478.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43885.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35107.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25628.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43372.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11534.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12688.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23936.84,"maximum":88472.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35024.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37253.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88472.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70777.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51666.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87439.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25580.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":41331.54,"10th_percentile":41331.54,"90th_percentile":41331.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12509.15,"maximum":47207.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18688.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19877.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47207.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37765.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27567.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13516.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46656.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12509.15},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":44998.47,"10th_percentile":44998.47,"90th_percentile":44998.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9645.07,"maximum":39424.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15607.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16600.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39424.05},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31538.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23022.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11288.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38963.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9645.07},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11398.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12471.19,"maximum":52632.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20836.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22162.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52632.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42105.84},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30736.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15070.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52018.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.19},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15218.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10899.85,"maximum":47108.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18649.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19836.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47108.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37686.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27510.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13488.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46558.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13620.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14027.49,"maximum":58481.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23151.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24625.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":58481.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46785.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34152.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57798.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14027.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16909.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12060.81,"maximum":52701.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20863.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22191.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52701.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42160.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30776.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15089.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52085.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12060.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15237.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14841.57,"maximum":52870.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20930.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22262.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52870.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42295.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30875.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15138.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52253.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14969.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15286.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8665.3,"maximum":32408.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12829.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13646.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32408.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25926.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18925.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32030.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8665.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9370.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5639.36,"maximum":23680.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9374.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9971.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23680.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18943.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13828.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6780.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23403.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5639.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6846.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15577.35,"maximum":57935.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22935.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24395.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57935.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46347.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33833.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16588.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57258.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15577.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16751.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7226.46,"maximum":29572.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11707.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12452.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29572.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23658.04},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17269.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8467.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29227.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7226.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8550.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11462.78,"maximum":45543.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18029.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19177.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45543.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36434.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26596.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13040.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45011.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11462.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13168.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8585.81,"maximum":30905.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12235.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13013.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30905.98},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24724.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18048.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30545.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8675.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4818.59,"maximum":21019.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8321.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8850.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21019.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16815.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12274.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20773.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4818.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6077.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7344.63,"maximum":28455.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11264.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11981.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28455.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22764.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16617.37},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28123.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7344.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4537.13,"maximum":16528.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6543.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6959.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16528.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13222.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9651.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16335.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4537.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4778.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10653.48,"maximum":38828.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15371.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16349.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38828.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31062.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22674.99},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11117.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38375.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.48},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11226.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6336.22,"maximum":23792.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9418.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23792.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19033.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13894.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23514.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6879.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":21424.7,"10th_percentile":21424.7,"90th_percentile":27627.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5515.35,"10th_percentile":5515.35,"90th_percentile":5515.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":16650.0,"10th_percentile":16650.0,"90th_percentile":16650.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10787.4,"maximum":40216.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15920.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16934.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40216.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32172.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23485.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39746.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10787.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11628.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6508.83,"maximum":25024.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9906.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25024.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20019.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14613.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24732.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6508.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7235.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11357.5,"maximum":41339.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16365.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17406.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41339.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33070.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24141.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40856.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11604.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11952.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6399.25,"maximum":24761.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9802.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10426.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24761.94},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19809.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14460.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7090.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24472.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6399.25},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16131.69,"maximum":59877.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23704.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25212.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59877.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47901.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34967.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17144.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59178.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.69},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17312.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10536.02,"maximum":38227.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15133.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16096.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38227.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30581.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22324.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10945.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37781.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11052.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26744.43,"maximum":95272.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37716.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40116.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":95272.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":76217.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55636.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27279.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94159.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28345.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27546.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9851.96,"10th_percentile":9851.96,"90th_percentile":9851.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14212.99,"maximum":51094.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20227.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21514.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":51094.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40875.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29838.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14629.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50498.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":40098.88,"10th_percentile":40098.88,"90th_percentile":40098.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12364.12,"10th_percentile":12364.12,"90th_percentile":12364.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8318.66,"maximum":38746.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15338.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16315.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38746.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30996.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22627.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11094.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38294.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.66},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11203.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18639.11,"maximum":78880.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31227.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33214.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":78880.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63104.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46064.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22585.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77959.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18639.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22807.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27295.05,"maximum":97233.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38492.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40942.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97233.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":77786.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56782.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27840.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96098.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27398.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28113.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13331.35,"maximum":49007.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19401.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20635.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49007.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39205.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28619.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48435.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13331.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14169.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7982.05,"maximum":34200.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13539.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14400.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":34200.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27360.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19972.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9792.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33801.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7982.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9888.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20921.63,"maximum":82506.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32662.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":82506.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":66004.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48181.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23623.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81542.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20921.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23855.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10684.99,"maximum":40962.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16216.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17248.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40962.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32769.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23920.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11728.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40483.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11843.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8852.23,"maximum":36287.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14365.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15279.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36287.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29030.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21191.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35864.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10492.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16206.17,"maximum":59522.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23563.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":59522.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":47617.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34759.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58827.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16206.17},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17210.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":73021.89,"10th_percentile":73021.89,"90th_percentile":73021.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15298.76,"10th_percentile":15298.76,"90th_percentile":15298.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10000.3,"maximum":39872.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15784.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16789.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39872.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31897.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23284.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11416.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39406.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10000.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10379.89,"maximum":39249.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15537.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16526.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39249.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31399.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22920.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11238.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38790.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10379.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11348.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6441.5,"maximum":24483.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9692.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10309.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24483.29},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19586.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14297.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24197.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6441.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6249.67,"10th_percentile":6249.67,"90th_percentile":6249.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":23769.91,"10th_percentile":23769.91,"90th_percentile":23769.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4458.35,"maximum":16970.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6718.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7145.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16970.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13576.33},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9910.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4859.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16772.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":8323.28,"10th_percentile":8323.28,"90th_percentile":8323.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9419.46,"maximum":36487.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14444.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36487.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29189.54},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21307.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36061.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9419.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5596.39,"maximum":21259.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8416.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8951.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21259.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17007.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12415.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6087.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21011.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5596.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":33218.94,"10th_percentile":33218.94,"90th_percentile":33218.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11872.59,"10th_percentile":11872.59,"90th_percentile":11872.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5315.22,"10th_percentile":5315.22,"90th_percentile":5315.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5096.39,"10th_percentile":5096.39,"90th_percentile":5096.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9334.23,"maximum":38850.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15380.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16358.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38850.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31080.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22687.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11124.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38396.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9334.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10905.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11233.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11782.21,"maximum":44969.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17802.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18935.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44969.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35975.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26261.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44444.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11782.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13002.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7603.9,"maximum":28001.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11085.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11790.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28001.98},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22401.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16352.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27675.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":27395.71,"10th_percentile":27395.71,"90th_percentile":27395.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5449.57,"maximum":20989.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8309.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8838.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20989.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16791.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12257.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20744.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5449.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5892.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32211.1,"maximum":128437.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50845.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54081.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":128437.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":102749.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75004.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36775.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126937.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32211.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36054.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37136.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24769.06,"maximum":101238.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40078.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42628.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":101238.75},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":80990.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59121.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100056.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24769.06},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28419.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29271.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21517.51,"maximum":88226.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34927.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37149.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88226.71},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70580.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51522.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25261.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87196.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21517.51},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25509.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38772.2,"maximum":141960.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56199.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59775.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":141960.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":113567.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82901.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40647.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140302.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38772.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41046.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19605.98,"maximum":76474.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30274.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32201.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":76474.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":61178.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44659.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21896.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75581.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19605.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22111.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15096.06,"maximum":57823.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22891.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24347.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57823.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46258.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33767.6},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16556.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57148.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15096.06},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22471.49,"maximum":86978.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34432.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36624.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86978.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":69581.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50793.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24904.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85962.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22471.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25148.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13208.16,"maximum":49993.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19791.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21051.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49993.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39994.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29195.27},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14314.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49410.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14455.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10602.62,"maximum":42393.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16782.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17850.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42393.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33914.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24756.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12138.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41898.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12257.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18541.7,"maximum":69414.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27479.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29228.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":69414.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":55531.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40536.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19875.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68604.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18541.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20070.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9639.34,"maximum":36107.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14294.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15203.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36107.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28885.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21086.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10338.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35685.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"1 through 10","median_amount":20682.0,"10th_percentile":20682.0,"90th_percentile":20682.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7508.64,"maximum":28286.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11197.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11910.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28286.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22628.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16518.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8099.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27955.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":30116.67,"10th_percentile":30116.67,"90th_percentile":32732.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6277.51,"10th_percentile":6277.51,"90th_percentile":6277.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21462.37,"maximum":83637.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33110.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35217.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":83637.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":66909.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48842.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23947.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82660.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21462.37},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24182.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10449.36,"maximum":41530.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16440.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17487.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41530.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33223.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24252.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11891.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41045.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10449.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12007.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7603.18,"maximum":28600.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11322.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12042.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28600.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22880.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16701.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28266.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22124.13,"maximum":85268.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33755.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35904.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":85268.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":68213.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49794.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24414.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84272.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22124.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24654.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12300.02,"maximum":47789.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18918.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47789.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38230.95},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27907.81},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47231.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12300.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7517.24,"maximum":30220.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11963.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12724.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30220.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24176.0},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17647.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29867.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7517.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8737.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20182.52,"maximum":79771.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31579.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33589.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":79771.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63816.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46584.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22840.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78840.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20182.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22393.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23064.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10990.81,"maximum":42399.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16784.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17853.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42399.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33918.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24760.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41904.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10990.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12259.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6894.14,"maximum":26698.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10569.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11242.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26698.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21358.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15591.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7644.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26387.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7719.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12260.63,"maximum":49037.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19412.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20648.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49037.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39229.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28636.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48465.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12260.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14178.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6714.38,"maximum":29490.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11674.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12417.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29490.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23592.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17222.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29146.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8526.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26485.08,"maximum":114783.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45440.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48332.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":114783.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":91825.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67031.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32865.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113443.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26485.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33188.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17061.32,"maximum":63888.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25291.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26901.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":63888.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":51110.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37309.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18293.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63142.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17061.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18472.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11362.51,"maximum":44841.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17751.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18881.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44841.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35872.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26186.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12839.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44317.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.51},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12965.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10748.73,"maximum":40459.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16017.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17036.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40459.44},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32367.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23627.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11584.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39987.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11698.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6451.53,"maximum":23925.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9471.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10074.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23925.98},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19140.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13972.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6850.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23646.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.53},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6640.4,"10th_percentile":6640.4,"90th_percentile":6640.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":23169.4,"10th_percentile":21717.09,"90th_percentile":53194.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4628.08,"maximum":18128.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7176.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7633.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18128.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14502.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10586.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5190.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17917.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4628.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5089.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7129.05,"maximum":27523.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10896.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11589.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27523.89},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22018.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16073.35},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27202.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4337.31,"maximum":15585.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6169.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6562.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":15585.49},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":12468.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9101.59},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4462.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15403.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4337.31},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4506.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8217.96,"maximum":29275.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11589.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12326.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29275.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23419.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17095.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28933.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8724.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8464.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11057.41,"maximum":46163.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18275.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19438.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46163.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36930.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26958.56},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45624.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11057.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13347.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5720.29,"maximum":27392.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10844.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11534.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27392.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21914.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15996.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7843.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27072.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5720.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6451.82,"maximum":22983.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9098.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9677.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22983.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18386.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13421.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6580.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22715.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7084.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6645.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12689.63,"maximum":67070.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26551.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28241.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":67070.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":53656.21},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39167.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66287.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.63},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19392.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7334.6,"maximum":28960.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11464.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12194.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28960.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23168.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16912.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8292.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28622.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7334.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8373.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. 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Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6204.44,"maximum":26166.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10358.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26166.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20932.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15280.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25860.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6204.44},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12529.92,"maximum":45062.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17839.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45062.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36049.82},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26315.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12902.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44536.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.92},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13029.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7527.98,"maximum":30509.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12078.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12846.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30509.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24407.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17817.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30153.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7527.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6123.51,"maximum":26193.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10369.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11029.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26193.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20954.57},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15296.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25887.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6123.51},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7352.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7573.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13030.54,"maximum":49234.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19490.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20731.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49234.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39387.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28751.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48659.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13030.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14235.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42972.72,"maximum":162370.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64278.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68369.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":162370.48},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":129895.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94820.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46491.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":160474.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42972.72},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45579.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46947.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29347.73,"maximum":110887.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43898.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46691.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":110887.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":88709.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64756.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31750.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109593.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32061.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17708.05,"maximum":66909.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26488.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28173.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":66909.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":53527.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39073.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66128.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17708.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19346.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30147.01,"maximum":113909.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45094.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47964.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":113909.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":91126.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66520.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32615.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112579.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30147.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32935.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10670.66,"maximum":40320.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15961.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16977.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40320.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32255.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23546.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11544.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39849.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.66},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11658.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1444.58,"maximum":5458.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2160.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2298.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":5458.34},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":4366.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3187.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1562.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5394.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1444.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1578.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8949.58,"maximum":31881.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12621.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13424.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31881.27},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25504.79},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18617.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31509.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10158.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7132.64,"maximum":27329.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10819.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11507.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27329.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21863.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15960.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27010.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7132.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7902.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5980.99,"maximum":26147.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10351.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11009.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26147.01},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20917.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15269.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25841.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7339.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34731.56,"maximum":123725.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48980.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52097.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":123725.02},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":98979.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72252.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35426.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":122280.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35484.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34731.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20180.37,"maximum":76750.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30383.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32317.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":76750.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":61399.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44820.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21975.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75853.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20180.37},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22191.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12817.83,"maximum":52149.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20644.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21958.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52149.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41719.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30454.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14931.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51540.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.83},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14639.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15078.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24571.39,"maximum":108841.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43088.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45830.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":108841.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":87072.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63561.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31164.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107570.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24571.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31470.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8668.88,"maximum":37044.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14665.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15598.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37044.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29635.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21633.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10606.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36612.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.88},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10710.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7220.73,"maximum":29482.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11671.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12414.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29482.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23585.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17217.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29138.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8524.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5347.87,"maximum":20598.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8154.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8673.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":20598.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":16478.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12029.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5897.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20358.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5347.87},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4686.1,"maximum":18418.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7291.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7755.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18418.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14734.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10755.98},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5273.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18203.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4686.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15685.5,"maximum":60317.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23878.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25398.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":60317.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":48253.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35224.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17270.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59613.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15685.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16932.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17440.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15783.13,"10th_percentile":15783.13,"90th_percentile":15783.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8625.91,"maximum":34583.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13690.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14562.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":34583.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27666.24},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20195.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34179.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.91},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7194.23,"maximum":28592.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11318.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12039.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28592.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22873.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16697.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28258.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9909.66,"10th_percentile":9909.66,"90th_percentile":9909.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10052.58,"maximum":38364.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15187.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16154.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38364.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30690.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22403.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10984.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37916.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10052.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6450.81,"maximum":25084.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9930.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10562.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25084.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20067.26},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14648.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24791.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6450.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7252.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6259.98,"10th_percentile":6259.98,"90th_percentile":6259.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11172.72,"maximum":41669.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16496.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17546.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41669.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33335.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24334.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41183.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11172.72},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12048.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15241.45,"maximum":58099.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23000.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24464.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":58099.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46479.03},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33928.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16635.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57420.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15241.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16309.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16798.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7120.46,"maximum":27701.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10966.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11664.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27701.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22160.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16177.05},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7931.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27378.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4846.73,"maximum":17265.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6835.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7270.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17265.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13812.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10082.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17064.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5086.45},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32242.61,"maximum":125252.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49584.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52740.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":125252.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":100200.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73144.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35863.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123789.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32242.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36215.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15992.03,"maximum":61893.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24502.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26061.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":61893.93},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":49514.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36144.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61171.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15992.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17895.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9249.01,"maximum":36864.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14593.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15522.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36864.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29491.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21527.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10555.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36433.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9249.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33143.59,"maximum":127792.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50590.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":127792.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":102233.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74628.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36590.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126300.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33143.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35873.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36949.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22587.52,"maximum":86328.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34175.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36350.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":86328.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":69061.8},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50413.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24718.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85320.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.52},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24960.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11324.55,"maximum":41115.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16276.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17312.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41115.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32891.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24010.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11772.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40635.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11324.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40100.04,"maximum":149978.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59373.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63152.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":149978.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":119981.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87584.22},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42943.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148227.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40100.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42101.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43364.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15995.74,"maximum":56981.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22557.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23993.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56981.97},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45585.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33276.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16315.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56316.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15995.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16475.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9352.19,"maximum":33315.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13188.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14028.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33315.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26652.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19455.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9539.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32926.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10112.03},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9632.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34692.73,"maximum":131248.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51958.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55265.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":131248.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":104997.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76646.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37580.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129716.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34692.73},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37948.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14336.18,"maximum":57025.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22575.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24012.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57025.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45620.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33301.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16328.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56359.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14336.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16488.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9332.8,"maximum":39445.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15615.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39445.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31556.43},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23035.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11294.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38985.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22382.68,"maximum":88374.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34985.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37212.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":88374.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70698.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51608.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87342.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22382.68},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25552.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11269.41,"maximum":44568.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17643.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18766.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44568.22},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35654.25},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26026.87},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44047.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11269.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12886.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7637.56,"maximum":27603.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10927.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11622.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27603.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22082.29},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16119.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7903.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27280.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.56},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7981.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13325.62,"maximum":54495.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21573.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22946.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54495.94},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43596.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31824.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15603.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53859.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15756.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8287.87,"maximum":33258.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13166.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14004.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33258.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26606.28},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19422.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32869.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.87},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9616.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6194.41,"maximum":23264.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9210.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9796.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23264.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18611.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13586.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22993.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6726.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17503.93,"maximum":70824.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28037.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29822.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":70824.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":56659.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41359.97},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20279.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69997.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17503.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19881.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20478.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. 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Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8684.64,"maximum":35738.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14148.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15048.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35738.72},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28590.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20870.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10233.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35321.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5988.86,"maximum":23204.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9186.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9770.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23204.76},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18563.64},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13551.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22933.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.86},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6709.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19275.81,"maximum":74020.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29303.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31168.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":74020.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":59216.12},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43226.55},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21194.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73156.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19275.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21402.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66408.61,"maximum":236568.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93652.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99612.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":236568.88},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":189253.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138151.07},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67736.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":233806.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68400.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35804.99,"maximum":134917.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53410.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56810.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":134917.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":107933.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78788.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38630.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":133342.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35804.99},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37873.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39009.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31743.7,"10th_percentile":31743.7,"90th_percentile":31743.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":34879.47,"10th_percentile":34879.47,"90th_percentile":34879.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14597.59,"maximum":54586.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21609.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22984.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54586.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43668.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31877.09},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53948.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14597.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15323.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15782.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":41192.67,"10th_percentile":41192.67,"90th_percentile":41192.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12282.49,"10th_percentile":12282.49,"90th_percentile":12282.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11481.84,"maximum":40902.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16192.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17222.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40902.01},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32721.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23885.88},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40424.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12188.29},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13192.4,"maximum":49821.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19723.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20978.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49821.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39856.96},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29094.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14265.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49239.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13192.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14405.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8853.86,"10th_percentile":8853.86,"90th_percentile":8853.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7201.39,"maximum":27261.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10792.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11479.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27261.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21809.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15920.2},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26943.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7201.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10410.45,"10th_percentile":10410.45,"90th_percentile":10410.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6322.61,"maximum":24251.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9600.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10211.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24251.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19400.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14162.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23967.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6322.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11490.27,"maximum":40932.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16204.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17235.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40932.06},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32745.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23903.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11720.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40454.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6572.57,"maximum":23756.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9404.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10003.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23756.6},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19005.11},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13873.34},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23479.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6868.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14985.05,"maximum":57184.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22637.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24078.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":57184.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45746.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33394.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56516.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16052.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16534.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7774.35,"maximum":28168.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11151.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11861.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28168.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22534.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16449.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8065.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27839.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7774.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8144.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5660.82,"10th_percentile":5660.82,"90th_percentile":5660.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4358.08,"maximum":16399.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6492.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6905.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16399.6},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13119.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9577.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4695.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16208.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4358.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4741.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4143.44,"10th_percentile":4143.44,"90th_percentile":4143.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13173.78,"maximum":49275.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19507.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20748.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49275.28},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39419.86},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28775.69},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14109.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48699.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13832.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14247.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7486.44,"maximum":28624.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11331.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12053.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28624.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22899.67},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16716.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8196.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28290.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.44},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5592.81,"maximum":21590.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8547.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9091.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21590.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17272.01},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12608.21},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21338.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5592.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8411.05,"maximum":31698.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12548.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13347.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31698.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25358.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18511.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31328.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8411.05},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5649.22,"10th_percentile":5649.22,"90th_percentile":5649.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5779.02,"maximum":22114.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8754.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9311.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22114.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17691.62},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12914.52},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21856.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5779.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":7746.85,"10th_percentile":7746.85,"90th_percentile":7746.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4822.42,"10th_percentile":4822.42,"90th_percentile":4822.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"1 through 10","median_amount":10467.21,"10th_percentile":10467.21,"90th_percentile":10467.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":31526.75,"10th_percentile":31526.75,"90th_percentile":31526.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10143.54,"maximum":36730.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14540.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36730.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29384.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21449.75},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36301.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.54},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10620.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5605.7,"maximum":21355.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8454.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8992.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21355.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17084.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12471.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21105.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5605.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8565.75,"maximum":31247.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12370.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31247.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24997.75},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18247.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8947.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30882.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8565.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9034.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4956.82,"maximum":18822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7451.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7925.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18822.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15058.1},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10992.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5389.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18603.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4956.82},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7972.02,"maximum":29444.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11656.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29444.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23555.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29100.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8513.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11848.81,"maximum":45196.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17892.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19031.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45196.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36156.91},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26393.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12941.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44668.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11848.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7310.97,"maximum":27728.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10977.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27728.79},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22182.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16193.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27405.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7310.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5072.84,"maximum":18847.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7461.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7936.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18847.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15077.76},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11006.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5396.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18627.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5072.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5449.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14051.13,"maximum":54646.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21633.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23010.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":54646.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":43716.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31912.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15646.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54008.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14051.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15340.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10445.78,"maximum":41912.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16592.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17648.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41912.81},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33529.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24476.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12000.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41423.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12118.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15547.27,"maximum":63574.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25167.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":63574.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":50858.77},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37125.86},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18203.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62831.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15547.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18381.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9291.26,"maximum":38279.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15153.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16118.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38279.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30623.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22354.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37832.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9291.26},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15204.21,"maximum":56927.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22536.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23970.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56927.33},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45541.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33244.32},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56262.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15204.21},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8433.46,"maximum":30042.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11893.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12650.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":30042.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24033.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17544.28},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29691.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8511.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8686.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4946.79,"maximum":19934.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7891.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8393.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19934.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15947.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11641.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19701.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4946.79},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5595.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49882.61,"maximum":188823.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74751.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79508.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":188823.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":151057.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110268.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54065.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":186618.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49882.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54595.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14199.38,"maximum":53067.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21008.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22345.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53067.16},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42453.34},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30990.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15194.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52447.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.38},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15343.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5448.06,"10th_percentile":5448.06,"90th_percentile":5448.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":29863.04,"10th_percentile":29863.04,"90th_percentile":52572.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14400.12,"10th_percentile":14400.12,"90th_percentile":14400.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5341.26,"10th_percentile":5341.26,"90th_percentile":5341.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7376.14,"maximum":27955.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11066.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27955.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22364.22},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16325.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27629.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.14},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8082.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":75412.9,"10th_percentile":75412.9,"90th_percentile":75412.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7384.02,"10th_percentile":7384.02,"90th_percentile":7384.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26725.0,"maximum":105585.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41798.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44459.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":105585.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":84467.39},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61659.46},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30232.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104352.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26725.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29639.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30528.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6836.85,"maximum":26231.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10384.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11045.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26231.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20985.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15318.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25925.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.85},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6492.35,"maximum":25704.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10175.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10823.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25704.45},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20563.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15010.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25404.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6492.35},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6727.27,"maximum":29335.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11613.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12352.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29335.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23467.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17131.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28992.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13431.61,"maximum":53717.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21265.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22618.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53717.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42973.49},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31369.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15380.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53090.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13431.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15531.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12338.45,"maximum":43953.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17400.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":43953.54},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35162.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25667.91},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12585.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43440.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12582.92},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9786.16,"maximum":38159.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15106.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16067.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38159.18},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30527.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22284.13},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37713.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12044.34,"maximum":56695.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22444.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23872.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56695.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45355.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33108.71},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16233.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56033.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12044.34},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16392.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8212.6,"maximum":29255.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11581.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12318.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29255.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23404.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17084.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8376.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28914.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.09},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4114.57,"maximum":16853.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6671.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7096.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":16853.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13482.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9841.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16656.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4114.57},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4872.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10856.06,"maximum":38672.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15309.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16284.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38672.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30937.94},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22584.06},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38221.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10856.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12734.75,"maximum":47674.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18873.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20074.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47674.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38139.16},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27840.8},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47117.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":70275.78,"10th_percentile":70275.78,"90th_percentile":70275.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6127.81,"maximum":24117.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9547.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10155.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24117.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19293.59},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14083.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23835.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.81},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":29584.58,"10th_percentile":29584.58,"90th_percentile":29584.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30995.7,"maximum":114646.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45386.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48274.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":114646.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":91716.69},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66951.3},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32826.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113308.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30995.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13498.22,"maximum":52302.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20705.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22023.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52302.23},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41841.4},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30543.36},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51691.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13498.22},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8891.62,"maximum":31952.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12649.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13454.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31952.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25561.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18659.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31579.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8891.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9238.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23320.9,"maximum":100345.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39724.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42252.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":100345.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":80275.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58599.54},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99173.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28168.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29013.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11342.46,"maximum":40525.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16042.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17064.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40525.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32419.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23665.72},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11603.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40051.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11342.46},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11717.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13476.02,"maximum":53662.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21243.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22595.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":53662.71},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":42929.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31337.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15365.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53036.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13476.02},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15515.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9713.82,"maximum":35861.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14196.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15100.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35861.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28689.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20942.42},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35442.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.82},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10368.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10703.61,"maximum":44655.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17678.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18803.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44655.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35724.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26077.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44134.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6500.95,"maximum":24190.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9576.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10186.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24190.97},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19352.6},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23908.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6994.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.39,"maximum":45939.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18186.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19343.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":45939.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":36751.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26827.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45403.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12705.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13282.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4718.33,"maximum":18202.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7206.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7664.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18202.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14561.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10629.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5211.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17990.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4718.33},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5109.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5263.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11429.84,"maximum":42847.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16962.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18041.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42847.12},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":34277.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25021.78},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42346.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12388.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6165.77,"maximum":23415.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9269.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9859.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23415.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18731.92},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13673.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6704.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23141.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.77},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13068.5,"maximum":50015.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19800.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21060.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50015.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40012.13},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29208.03},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14320.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49431.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14040.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14461.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7404.08,"maximum":27381.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10839.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11529.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27381.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21905.27},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15990.39},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27062.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7404.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7917.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6703.3,"10th_percentile":6703.3,"90th_percentile":6703.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4997.64,"maximum":18806.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7445.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7918.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18806.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15044.98},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10982.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5384.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18586.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4997.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5437.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12496.97,"maximum":47791.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18919.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20123.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47791.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38233.14},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27909.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13684.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47233.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12496.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13818.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7243.65,"maximum":27802.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11006.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11706.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27802.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":22241.83},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16236.08},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27477.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8038.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":163734.28,"maximum":583274.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230905.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":245601.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":583274.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":466615.18},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340619.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167008.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":576463.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188781.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168646.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49558.89,"maximum":195950.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77572.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82509.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":195950.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":156759.36},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114431.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56106.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":193662.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49558.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56656.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23029.41,"maximum":87989.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34832.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37049.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":87989.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":70390.58},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51383.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86961.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23029.41},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24699.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25440.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21715.18,"maximum":106385.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42115.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44796.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":106385.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":85107.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62126.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105143.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21715.18},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30760.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14986.49,"maximum":60391.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23907.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25429.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":60391.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":48312.66},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35267.25},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17291.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59686.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14986.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14618.36,"maximum":56277.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22278.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23696.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56277.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45021.3},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32864.62},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55620.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14618.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23027.98,"maximum":99126.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39242.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41739.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":99126.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":79300.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57888.0},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28383.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97969.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23027.98},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27826.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28661.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10811.04,"maximum":42306.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16748.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17814.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42306.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33844.65},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24705.9},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12113.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41812.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7252.96,"maximum":31329.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12402.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13191.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31329.43},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25063.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18295.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30963.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7252.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9058.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8963.96,"maximum":34678.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13728.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14602.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":34678.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27742.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20251.63},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34273.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10026.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5736.76,"maximum":21868.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8657.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9208.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21868.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17494.93},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12770.94},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21613.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5736.76},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6138.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7683.39,"maximum":32501.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12866.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13685.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32501.41},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26000.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18980.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32121.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7683.39},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4573.65,"maximum":17148.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6788.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7220.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17148.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":13718.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10014.14},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4910.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16947.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4573.65},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4813.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4958.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4225.58,"maximum":15189.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6013.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6395.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":15189.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":12151.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8870.26},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4349.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15012.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4225.58},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4391.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43618.01,"maximum":183886.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72796.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77429.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":183886.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":147108.19},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107385.95},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52652.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":181739.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43618.01},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53168.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27775.67,"maximum":102801.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40696.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43286.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":102801.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":82240.37},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60033.77},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29435.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101601.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27775.67},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29723.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19583.06,"maximum":74684.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29566.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31447.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":74684.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":59747.2},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43614.23},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21384.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73812.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19583.06},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20965.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21594.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10750.16,"maximum":41869.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16575.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17629.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41869.1},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33494.97},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24450.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41380.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12105.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6846.16,"maximum":25693.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10171.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10818.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":25693.52},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20554.63},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15004.45},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25393.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6846.16},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19907.5,"maximum":72051.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28523.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30338.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":72051.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":57640.38},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42076.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20630.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71209.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19907.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20832.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20887.97,"maximum":78842.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31212.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33198.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":78842.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":63073.53},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46042.38},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22575.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77922.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20887.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22796.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9763.95,"maximum":35378.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14005.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14896.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35378.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28302.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20660.04},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34965.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.95},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10229.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6054.04,"maximum":24660.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9762.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":24660.86},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":19728.51},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14401.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24372.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6054.04},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7130.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9951.9,"maximum":35451.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14034.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14927.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":35451.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":28361.23},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20703.12},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35037.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15632.78,"10th_percentile":15632.78,"90th_percentile":15632.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11711.3,"maximum":46824.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18536.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19716.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":46824.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37459.47},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27344.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46278.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11711.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13538.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24183.93,"maximum":93660.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37078.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39437.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":93660.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":74927.68},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54695.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26817.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92566.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24183.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27080.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12153.91,"maximum":44901.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17775.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18906.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44901.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35920.88},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26221.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12856.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44377.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12153.91},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12982.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7737.11,"maximum":32760.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12969.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13794.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32760.94},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26208.52},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19131.68},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9380.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32378.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7737.11},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9196.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"1 through 10","median_amount":25230.98,"10th_percentile":25230.98,"90th_percentile":25230.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82806.13,"maximum":209170.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82806.13},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":209170.66},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":167334.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122151.1},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":206728.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56440.24,"maximum":142569.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56440.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":142569.67},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":114054.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83257.57},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140904.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76669.7,"maximum":193669.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76669.7},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":193669.85},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":154934.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113098.97},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":191408.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54699.03,"maximum":138171.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54699.03},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":138171.31},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":110536.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80689.03},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136557.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69225.73,"maximum":174866.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69225.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":174866.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":139891.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102118.04},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":172824.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54298.87,"maximum":137160.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54298.87},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":137160.5},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":109727.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80098.74},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":135558.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32395.25,"maximum":81831.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32395.25},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":81831.33},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":65464.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47787.71},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80875.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20651.24,"maximum":52165.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20651.24},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":52165.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":41732.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30463.59},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51556.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32550.99,"maximum":82224.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32550.99},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":82224.73},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":65779.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48017.45},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81264.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19647.61,"maximum":49630.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19647.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49630.43},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39703.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28983.09},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49050.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28730.05,"maximum":72572.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28730.05},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":72572.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":58057.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42381.0},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71725.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17611.15,"maximum":44486.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17611.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":44486.26},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":35588.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25979.01},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43966.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12976.92,"maximum":32780.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12976.92},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":32780.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26223.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19142.84},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32397.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24431.09,"maximum":61713.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24431.09},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":61713.62},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":49370.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36039.41},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60993.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15716.36,"maximum":39699.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15716.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39699.97},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31759.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23183.92},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39236.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11817.55,"maximum":29851.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11817.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29851.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23880.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17432.61},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29502.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63465.35,"maximum":242084.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95836.04},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":242084.59},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":193665.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141372.12},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":239257.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63465.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43804.94,"maximum":167091.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66147.78},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":167091.2},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":133671.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97577.62},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":165140.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43804.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32985.31,"maximum":125820.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49809.56},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":125820.39},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":100655.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73476.36},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124351.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32985.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47500.53,"maximum":181187.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71728.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":181187.8},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":144948.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105809.72},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":179072.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47500.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26197.88,"maximum":99930.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39560.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":99930.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":79943.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58357.04},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98763.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26197.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10821.07,"maximum":42240.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16722.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":42240.64},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":33792.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24667.61},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41747.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10821.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7283.04,"maximum":27258.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10791.21},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":27258.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21806.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15918.6},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26940.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5305.61,"maximum":18213.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7210.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18213.58},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14570.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10636.33},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18000.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5305.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7833.08,"maximum":33545.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13279.74},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33545.0},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":26835.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19589.55},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33153.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7833.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5708.83,"maximum":21576.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8541.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":21576.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17261.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12600.23},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21324.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5708.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9784.01,"maximum":47985.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18996.55},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47985.82},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":38388.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28022.67},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47425.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9784.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10389.91,"maximum":41071.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16259.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17294.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":41071.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32856.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23984.79},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40591.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.91},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11875.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6864.78,"maximum":28887.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11435.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12163.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28887.11},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23109.48},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16869.44},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8271.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28549.8},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6864.78},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8109.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8352.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8421.08,"maximum":36692.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14525.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15450.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36692.15},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29353.45},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21427.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36263.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.08},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13427.32,"maximum":49439.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19571.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20817.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49439.19},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39550.99},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28871.41},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14155.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48861.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13427.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14294.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7980.62,"maximum":31217.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12358.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13144.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31217.42},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24973.71},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18230.29},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30852.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8763.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5028.48,"maximum":17913.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7091.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7542.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":17913.07},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14330.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10460.84},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17703.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5797.64},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5179.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8887.33,"maximum":31968.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12655.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13461.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31968.69},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":25574.72},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18669.02},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9153.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31595.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.33},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5234.71,"maximum":19724.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7808.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8305.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":19724.32},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":15779.31},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11518.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19494.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5234.71},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11372.17,"maximum":40511.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16037.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17058.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40511.35},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32408.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23657.74},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40038.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11609.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5730.32,"maximum":22161.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8773.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9331.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":22161.17},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":17728.78},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12941.64},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21902.4},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7189.93,"maximum":28922.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11449.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12178.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":28922.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23137.89},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16890.18},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28584.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.93},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8362.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4451.9,"maximum":18358.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7267.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":18358.37},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":14686.56},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10720.89},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5256.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18144.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4451.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15567.32,"maximum":58189.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23035.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24502.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":58189.47},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":46551.15},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33981.38},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16661.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57510.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15567.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16824.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9025.55,"maximum":36757.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14551.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15477.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":36757.71},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":29405.9},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21465.7},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36328.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9025.55},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10628.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27412.39,"maximum":97651.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38658.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41118.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97651.77},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":78120.7},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57026.5},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27960.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96511.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27840.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27412.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28234.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14136.36,"maximum":56293.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22285.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23703.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":56293.53},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":45034.41},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32874.19},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16118.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55636.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14136.36},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16276.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9773.27,"maximum":40117.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15881.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16892.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40117.95},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32094.07},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23428.01},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39649.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.27},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25899.94,"maximum":97878.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38747.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41214.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":97878.51},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":78302.09},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57158.92},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28025.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96735.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25899.94},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27476.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28300.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12798.49,"maximum":49436.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19570.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20816.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":49436.46},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":39548.81},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28869.82},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14155.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48859.2},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.49},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14293.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9305.59,"maximum":38959.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15423.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16404.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":38959.63},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31167.42},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22751.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38504.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.59},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12761.97,"maximum":50124.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19843.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21106.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50124.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40099.55},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29271.85},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49539.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.97},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14070.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14492.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8322.24,"maximum":33894.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13418.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14272.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":33894.68},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":27115.5},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19793.76},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33498.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.24},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13481.75,"maximum":55979.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22161.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":55979.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":44783.08},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32690.73},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16028.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55325.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13481.75},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7419.12,"maximum":31075.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12302.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13085.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":31075.36},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":24860.06},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18147.33},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30712.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7419.12},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8985.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12004.23,"maximum":47455.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18786.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19982.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":47455.83},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":37964.32},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27713.17},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46901.7},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13721.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6354.13,"maximum":23486.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9297.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9889.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":23486.14},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":18788.74},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13715.4},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6724.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23211.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6354.13},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10061.89,"maximum":37899.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15003.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15958.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":37899.65},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":30319.44},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22132.57},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37457.1},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10061.89},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10958.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. 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Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9740.32,"maximum":40317.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15960.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16976.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":40317.38},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":32253.61},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23544.47},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11544.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39846.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.32},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11657.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13267.61,"maximum":50313.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19917.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21185.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":50313.4},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":40250.35},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29381.93},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14406.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49725.9},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.61},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7768.62,"maximum":29717.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11764.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12513.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":29717.61},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":23773.87},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17354.43},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8509.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29370.6},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.62},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8592.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7088.23,"maximum":26239.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10387.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11048.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26239.9},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":20991.73},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15323.53},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25933.5},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.23},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7586.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10682.84,"maximum":39118.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15486.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16471.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":39118.08},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":31294.17},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22844.1},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38661.3},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.84},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10981.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11310.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7109.0,"maximum":26745.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10587.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"fee schedule","standard_charge_dollar":26745.3},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"fee schedule","standard_charge_dollar":21396.05},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15618.67},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7657.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26433.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.0},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 150000 | Total % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22831 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 17671 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 2128] [Lower Level Neonate-Per Diem: 6449] [Higher Level Neonate-Per Diem: 11609] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.01 | Excess % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20318 Days: 4 Additional Days: 2852] [Normal vag. Del. 4 day stay-Case Rate: 14832 Days: 4 Additional Days: 2852] [Normal Newborn-Per Diem: 1742] [Lower Level Neonate-Per Diem: 5160] [Higher Level Neonate-Per Diem: 10319] [Alcohol/ Chemical Dependency (%BC): 50] [Psych (%BC): 50] [Rehab (%BC): 50] [SNF-(% BC): 46] [ECT (%BC): 50] [All Other IP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 51.6] [All Other IP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 137813 | Total % of Charge: 52] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 126000 | Total % of Charge: 64] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3447] [Surgical-Per Diem: 3447] [ICU-Per Diem: 4471] [CCU-Per Diem: 4471] [Step Down-Per Diem: 3447] [C-Section 4 day stay-Case Rate: 7825 Days: 4 Additional Days: 2795] [Normal vag. Del. 2 day stay-Case Rate: 5589 Days: 2 Additional Days: 2795] [Nursery  Level 1- Boarder-Per Diem: 2329] [Nursery  Level 2-Per Diem: 2796] [Nursery  Level 3-Per Diem: 5123] [Nursery  Level 4-NICU-Per Diem: 5822] [Rehab-Per Diem: 2782] [SNF-(% BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":9265.48,"10th_percentile":9265.48,"90th_percentile":9265.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Obinutuzumab inj","code_information":[{"code":"1476","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":37489.02,"10th_percentile":37489.02,"90th_percentile":37489.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":124.99,"10th_percentile":124.99,"90th_percentile":132.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.66,"10th_percentile":131.66,"90th_percentile":131.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":241.25,"10th_percentile":241.25,"90th_percentile":241.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":89.94,"10th_percentile":89.94,"90th_percentile":89.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":402.58,"10th_percentile":402.58,"90th_percentile":402.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":417.03,"10th_percentile":402.58,"90th_percentile":2334.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1217.24,"10th_percentile":1217.24,"90th_percentile":1217.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":417.18,"10th_percentile":417.18,"90th_percentile":417.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"80","median_amount":437.17,"10th_percentile":149.74,"90th_percentile":671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"16","median_amount":164.18,"10th_percentile":40.64,"90th_percentile":281.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":236.7,"10th_percentile":118.35,"90th_percentile":247.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"41","median_amount":727.0,"10th_percentile":327.0,"90th_percentile":727.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":1103.54,"10th_percentile":1103.54,"90th_percentile":1103.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"389","median_amount":944.74,"10th_percentile":566.87,"90th_percentile":1480.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"42","median_amount":587.68,"10th_percentile":150.0,"90th_percentile":864.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":83.38,"10th_percentile":83.38,"90th_percentile":161.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":171.05,"10th_percentile":171.05,"90th_percentile":171.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":129.42,"10th_percentile":24.58,"90th_percentile":164.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":131.66,"10th_percentile":102.62,"90th_percentile":212.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"16","median_amount":157.34,"10th_percentile":125.0,"90th_percentile":164.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"96","median_amount":930.14,"10th_percentile":261.5,"90th_percentile":1375.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":77.73,"10th_percentile":77.73,"90th_percentile":77.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"214","median_amount":662.18,"10th_percentile":300.0,"90th_percentile":1290.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"96","median_amount":285.27,"10th_percentile":160.37,"90th_percentile":532.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"34","median_amount":432.96,"10th_percentile":200.0,"90th_percentile":762.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"75","median_amount":1598.09,"10th_percentile":899.62,"90th_percentile":2292.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":1629.0,"10th_percentile":1629.0,"90th_percentile":1629.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"977","median_amount":1599.5,"10th_percentile":987.23,"90th_percentile":3573.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"129","median_amount":996.86,"10th_percentile":561.51,"90th_percentile":2102.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":204.47,"10th_percentile":191.38,"90th_percentile":601.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":299.36,"10th_percentile":296.99,"90th_percentile":390.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":272.48,"10th_percentile":125.0,"90th_percentile":500.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"100","median_amount":199.62,"10th_percentile":112.1,"90th_percentile":401.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"52","median_amount":285.37,"10th_percentile":160.37,"90th_percentile":500.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"244","median_amount":1330.4,"10th_percentile":510.36,"90th_percentile":1721.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":280.58,"10th_percentile":170.88,"90th_percentile":599.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"206","median_amount":1524.64,"10th_percentile":350.88,"90th_percentile":2519.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"114","median_amount":666.9,"10th_percentile":312.5,"90th_percentile":1158.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"34","median_amount":745.36,"10th_percentile":371.27,"90th_percentile":1539.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"71","median_amount":3501.49,"10th_percentile":2069.15,"90th_percentile":4429.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3002.53,"10th_percentile":3002.53,"90th_percentile":3002.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"883","median_amount":5355.71,"10th_percentile":2201.36,"90th_percentile":11786.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"97","median_amount":2586.48,"10th_percentile":1260.6,"90th_percentile":5085.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1218.13,"10th_percentile":1218.13,"90th_percentile":1218.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":597.89,"10th_percentile":597.89,"90th_percentile":597.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"77","median_amount":653.19,"10th_percentile":374.62,"90th_percentile":1119.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"62","median_amount":389.82,"10th_percentile":136.32,"90th_percentile":888.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1057.63,"10th_percentile":1057.63,"90th_percentile":1057.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"54","median_amount":615.45,"10th_percentile":346.81,"90th_percentile":1154.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"239","median_amount":2376.0,"10th_percentile":1008.9,"90th_percentile":2459.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":826.54,"10th_percentile":608.6,"90th_percentile":1219.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"70","median_amount":1598.91,"10th_percentile":386.27,"90th_percentile":4039.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"48","median_amount":801.01,"10th_percentile":418.79,"90th_percentile":1888.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"17","median_amount":624.08,"10th_percentile":153.51,"90th_percentile":2404.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"33","median_amount":3926.69,"10th_percentile":1387.63,"90th_percentile":4429.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3457.37,"10th_percentile":3457.37,"90th_percentile":3457.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"344","median_amount":5558.82,"10th_percentile":3204.12,"90th_percentile":14362.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"37","median_amount":3200.35,"10th_percentile":922.44,"90th_percentile":6275.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1027.46,"10th_percentile":976.47,"90th_percentile":1148.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":799.83,"10th_percentile":140.0,"90th_percentile":2707.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":453.69,"10th_percentile":249.48,"90th_percentile":861.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"30","median_amount":964.89,"10th_percentile":628.09,"90th_percentile":1564.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"83","median_amount":2970.0,"10th_percentile":1830.23,"90th_percentile":3074.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":581.76,"10th_percentile":581.76,"90th_percentile":581.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":3068.61,"10th_percentile":3068.61,"90th_percentile":3068.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":4672.0,"10th_percentile":4672.0,"90th_percentile":4672.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"19","median_amount":396.53,"10th_percentile":285.64,"90th_percentile":517.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":367.27,"10th_percentile":367.27,"90th_percentile":367.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5635.28,"10th_percentile":5635.28,"90th_percentile":5635.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":7504.49,"10th_percentile":7504.49,"90th_percentile":7504.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"60","median_amount":814.75,"10th_percentile":449.82,"90th_percentile":2100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"23","median_amount":456.26,"10th_percentile":156.26,"90th_percentile":1048.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":157.49,"10th_percentile":157.49,"90th_percentile":157.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1037.8,"10th_percentile":903.43,"90th_percentile":1502.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":580.96,"10th_percentile":580.96,"90th_percentile":580.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":1646.98,"10th_percentile":727.0,"90th_percentile":8732.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"16","median_amount":1454.13,"10th_percentile":812.38,"90th_percentile":2290.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1200.8,"10th_percentile":1128.96,"90th_percentile":4592.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":492.27,"10th_percentile":492.27,"90th_percentile":492.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":693.83,"10th_percentile":693.83,"90th_percentile":693.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1426.39,"10th_percentile":500.0,"90th_percentile":1721.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1171.49,"10th_percentile":1171.49,"90th_percentile":1171.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1663.0,"10th_percentile":1663.0,"90th_percentile":1663.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":10340.61,"10th_percentile":10340.61,"90th_percentile":10340.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1069.4,"10th_percentile":1069.4,"90th_percentile":1428.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":575.01,"10th_percentile":575.01,"90th_percentile":718.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2800.89,"10th_percentile":2800.89,"90th_percentile":2800.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":7590.52,"10th_percentile":1087.85,"90th_percentile":12308.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6709.56,"10th_percentile":6709.56,"90th_percentile":6709.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":718.77,"10th_percentile":718.77,"90th_percentile":718.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":651.39,"10th_percentile":651.39,"90th_percentile":651.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":2574.0,"10th_percentile":1752.9,"90th_percentile":5524.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":3344.83,"10th_percentile":3007.78,"90th_percentile":4012.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1539.28,"10th_percentile":1539.28,"90th_percentile":1539.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1900.1,"10th_percentile":1519.3,"90th_percentile":2650.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5894.04,"10th_percentile":4439.63,"90th_percentile":7972.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5735.04,"10th_percentile":5735.04,"90th_percentile":5735.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"17","median_amount":6931.9,"10th_percentile":5749.15,"90th_percentile":11916.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4413.05,"10th_percentile":4413.05,"90th_percentile":4413.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1663.19,"10th_percentile":1663.19,"90th_percentile":2931.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":3525.95,"10th_percentile":2115.61,"90th_percentile":5384.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":2580.79,"10th_percentile":2580.79,"90th_percentile":2580.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":13784.53,"10th_percentile":7563.29,"90th_percentile":17858.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8913.45,"10th_percentile":8913.45,"90th_percentile":8913.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2531.79,"10th_percentile":2531.79,"90th_percentile":2531.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":8556.8,"10th_percentile":8556.8,"90th_percentile":8556.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":3918.51,"10th_percentile":3918.51,"90th_percentile":3918.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":8956.17,"10th_percentile":8956.17,"90th_percentile":8956.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8269.0,"10th_percentile":8269.0,"90th_percentile":8269.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":9.73,"10th_percentile":9.73,"90th_percentile":9.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":1108.1,"10th_percentile":976.48,"90th_percentile":2270.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2264.11,"10th_percentile":2264.11,"90th_percentile":2264.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":4822.37,"10th_percentile":4822.37,"90th_percentile":4822.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":701.81,"10th_percentile":701.81,"90th_percentile":701.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4562.0,"10th_percentile":4562.0,"90th_percentile":12020.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"12","median_amount":8493.64,"10th_percentile":3477.73,"90th_percentile":11835.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1525.71,"10th_percentile":1525.71,"90th_percentile":1525.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":2459.0,"10th_percentile":1548.9,"90th_percentile":4524.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1561.48,"10th_percentile":1561.48,"90th_percentile":1561.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":5075.63,"10th_percentile":4684.61,"90th_percentile":8002.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":3327.84,"10th_percentile":3327.84,"90th_percentile":3328.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4902.84,"10th_percentile":3551.37,"90th_percentile":10172.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":9691.0,"10th_percentile":8819.14,"90th_percentile":14113.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"46","median_amount":17201.4,"10th_percentile":10090.97,"90th_percentile":35957.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8269.0,"10th_percentile":7808.34,"90th_percentile":22003.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1.48,"10th_percentile":1.48,"90th_percentile":1.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2922.6,"10th_percentile":2922.6,"90th_percentile":2922.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2057.62,"10th_percentile":2057.62,"90th_percentile":2057.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3558.59,"10th_percentile":3558.59,"90th_percentile":3558.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"14","median_amount":10918.16,"10th_percentile":8843.34,"90th_percentile":14736.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3120.05,"10th_percentile":3120.05,"90th_percentile":3120.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"12","median_amount":23403.69,"10th_percentile":21456.66,"90th_percentile":39926.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":7311.23,"10th_percentile":7304.83,"90th_percentile":9538.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":13978.21,"10th_percentile":13978.21,"90th_percentile":16496.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"11","median_amount":34576.71,"10th_percentile":24593.28,"90th_percentile":56855.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"75","median_amount":43276.67,"10th_percentile":26883.19,"90th_percentile":70288.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":30398.0,"10th_percentile":16512.45,"90th_percentile":43103.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7307.3,"10th_percentile":7305.83,"90th_percentile":10868.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7686.59,"10th_percentile":6621.19,"90th_percentile":8934.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6443.42,"10th_percentile":6443.42,"90th_percentile":7497.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"17","median_amount":29743.66,"10th_percentile":17919.27,"90th_percentile":41006.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7521.27,"10th_percentile":7521.27,"90th_percentile":7521.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":40433.64,"10th_percentile":40433.64,"90th_percentile":51167.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":13619.36,"10th_percentile":13035.56,"90th_percentile":13705.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":25518.07,"10th_percentile":25518.07,"90th_percentile":25518.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":32992.67,"10th_percentile":32992.67,"90th_percentile":32992.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"13","median_amount":76630.0,"10th_percentile":66977.21,"90th_percentile":89320.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13285.94,"10th_percentile":13285.94,"90th_percentile":13285.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13947.42,"10th_percentile":13947.42,"90th_percentile":13947.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13949.92,"10th_percentile":13949.92,"90th_percentile":13949.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":47953.45,"10th_percentile":47953.45,"90th_percentile":64217.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":18985.86,"10th_percentile":18819.41,"90th_percentile":21785.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":22945.89,"10th_percentile":22945.89,"90th_percentile":22945.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":72691.4,"10th_percentile":72691.4,"90th_percentile":98260.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18794.26,"10th_percentile":18794.26,"90th_percentile":18794.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":108525.63,"10th_percentile":108525.63,"90th_percentile":108525.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":1504.54,"10th_percentile":1504.54,"90th_percentile":1504.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":10011.26,"10th_percentile":10011.26,"90th_percentile":10011.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":17941.78,"10th_percentile":17941.78,"90th_percentile":17941.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":3771.98,"10th_percentile":3771.98,"90th_percentile":3773.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":31099.58,"10th_percentile":27575.01,"90th_percentile":36923.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5805.42,"10th_percentile":5805.42,"90th_percentile":5805.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3540.96,"10th_percentile":3540.96,"90th_percentile":3540.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":9157.07,"10th_percentile":9157.07,"90th_percentile":9157.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":33059.27,"10th_percentile":31085.52,"90th_percentile":64402.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6162.26,"10th_percentile":6162.26,"90th_percentile":6162.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":38167.31,"10th_percentile":38167.31,"90th_percentile":38167.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":1737.72,"10th_percentile":1737.72,"90th_percentile":1737.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":183.39,"10th_percentile":183.39,"90th_percentile":183.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5396.41,"10th_percentile":5396.41,"90th_percentile":5396.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":5161.78,"10th_percentile":5045.16,"90th_percentile":5382.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1255.91,"10th_percentile":1255.91,"90th_percentile":1255.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1921.55,"10th_percentile":1281.03,"90th_percentile":2001.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":3447.64,"10th_percentile":3447.64,"90th_percentile":3447.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":6368.62,"10th_percentile":4806.77,"90th_percentile":10269.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":9357.79,"10th_percentile":5315.0,"90th_percentile":10948.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2725.05,"10th_percentile":2725.05,"90th_percentile":2725.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"21","median_amount":13334.21,"10th_percentile":6326.35,"90th_percentile":23455.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8269.0,"10th_percentile":5950.13,"90th_percentile":12161.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2893.99,"10th_percentile":1817.7,"90th_percentile":4687.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":9183.52,"10th_percentile":7223.18,"90th_percentile":15888.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":7468.21,"10th_percentile":6434.0,"90th_percentile":10567.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":6049.17,"10th_percentile":6049.17,"90th_percentile":6049.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":14257.54,"10th_percentile":13123.85,"90th_percentile":22243.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"20","median_amount":22804.82,"10th_percentile":11464.85,"90th_percentile":47936.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":25303.16,"10th_percentile":25303.16,"90th_percentile":25303.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6046.27,"10th_percentile":6046.27,"90th_percentile":6046.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1893.28,"10th_percentile":1817.7,"90th_percentile":2893.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":17929.95,"10th_percentile":17929.95,"90th_percentile":17929.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":15160.84,"10th_percentile":15160.84,"90th_percentile":15160.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2518.48,"10th_percentile":2518.48,"90th_percentile":2518.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":811.52,"10th_percentile":811.52,"90th_percentile":811.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1341.95,"10th_percentile":1341.95,"90th_percentile":1341.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":3860.31,"10th_percentile":3860.31,"90th_percentile":3860.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":9224.57,"10th_percentile":9224.57,"90th_percentile":9224.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4921.53,"10th_percentile":4921.53,"90th_percentile":4921.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":10177.86,"10th_percentile":10177.86,"90th_percentile":10177.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":14688.05,"10th_percentile":14688.05,"90th_percentile":14688.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":2510.29,"10th_percentile":2510.29,"90th_percentile":2510.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1372.0,"10th_percentile":1372.0,"90th_percentile":3095.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2164.95,"10th_percentile":2164.95,"90th_percentile":2164.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":27461.5,"10th_percentile":27461.5,"90th_percentile":27461.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":4596.19,"10th_percentile":4596.19,"90th_percentile":8996.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":998.37,"10th_percentile":998.37,"90th_percentile":998.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":978.69,"10th_percentile":978.69,"90th_percentile":978.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1059.02,"10th_percentile":760.54,"90th_percentile":1086.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":2951.2,"10th_percentile":2951.2,"90th_percentile":2951.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"17","median_amount":6276.48,"10th_percentile":2178.79,"90th_percentile":7781.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"26","median_amount":964.78,"10th_percentile":614.78,"90th_percentile":1424.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"13","median_amount":1466.0,"10th_percentile":1166.0,"90th_percentile":2180.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4433.0,"10th_percentile":4433.0,"90th_percentile":6704.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"83","median_amount":12510.16,"10th_percentile":10521.8,"90th_percentile":16246.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7136.88,"10th_percentile":6091.18,"90th_percentile":8564.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1423.47,"10th_percentile":1423.47,"90th_percentile":1423.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":863.13,"10th_percentile":713.13,"90th_percentile":965.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":633.37,"10th_percentile":633.37,"90th_percentile":633.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":712.79,"10th_percentile":570.69,"90th_percentile":1423.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"16","median_amount":7061.68,"10th_percentile":6429.97,"90th_percentile":11355.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":8573.1,"10th_percentile":7525.38,"90th_percentile":10351.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1804.72,"10th_percentile":1799.22,"90th_percentile":1807.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":10482.38,"10th_percentile":10482.38,"90th_percentile":10482.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"16","median_amount":15445.0,"10th_percentile":12664.07,"90th_percentile":18984.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8269.0,"10th_percentile":8269.0,"90th_percentile":8269.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1949.91,"10th_percentile":1949.91,"90th_percentile":1949.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":940.06,"10th_percentile":940.06,"90th_percentile":940.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1717.8,"10th_percentile":1717.8,"90th_percentile":1717.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":11935.6,"10th_percentile":11935.6,"90th_percentile":11935.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"13","median_amount":6427.91,"10th_percentile":6016.76,"90th_percentile":6718.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":931.37,"10th_percentile":864.19,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1425.57,"10th_percentile":1425.57,"90th_percentile":1425.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4433.0,"10th_percentile":4304.0,"90th_percentile":4433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2941.0,"10th_percentile":2941.0,"90th_percentile":2941.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"77","median_amount":10190.71,"10th_percentile":9441.85,"90th_percentile":12242.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":7890.83,"10th_percentile":6079.53,"90th_percentile":8269.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":864.19,"90th_percentile":1292.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":647.19,"10th_percentile":647.19,"90th_percentile":940.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.38,"10th_percentile":931.38,"90th_percentile":1686.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"20","median_amount":6673.73,"10th_percentile":6098.47,"90th_percentile":8376.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"50","median_amount":6626.18,"10th_percentile":1628.3,"90th_percentile":8991.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"48","median_amount":1544.38,"10th_percentile":1115.82,"90th_percentile":2285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"21","median_amount":2249.8,"10th_percentile":1843.65,"90th_percentile":2765.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"34","median_amount":5517.88,"10th_percentile":5176.0,"90th_percentile":8211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5474.0,"10th_percentile":5474.0,"90th_percentile":5474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"232","median_amount":12676.71,"10th_percentile":10655.57,"90th_percentile":18220.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"12","median_amount":8269.0,"10th_percentile":7056.06,"90th_percentile":8698.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":1204.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":1291.42,"10th_percentile":1115.82,"90th_percentile":1683.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":940.06,"10th_percentile":647.19,"90th_percentile":940.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1061.55,"10th_percentile":1061.55,"90th_percentile":1683.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"58","median_amount":7907.86,"10th_percentile":6601.46,"90th_percentile":11738.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":996.65,"10th_percentile":996.65,"90th_percentile":996.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":49347.85,"10th_percentile":49347.85,"90th_percentile":49347.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":22679.49,"10th_percentile":20014.88,"90th_percentile":48027.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":15918.48,"10th_percentile":15918.48,"90th_percentile":15918.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"16","median_amount":7440.96,"10th_percentile":2857.17,"90th_percentile":16402.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":5967.21,"10th_percentile":5617.21,"90th_percentile":5972.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9122.78,"10th_percentile":9122.78,"90th_percentile":12282.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":20584.34,"10th_percentile":16662.16,"90th_percentile":23375.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"48","median_amount":30752.02,"10th_percentile":17864.01,"90th_percentile":45261.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":8269.0,"10th_percentile":8269.0,"90th_percentile":8832.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5568.79,"10th_percentile":5461.85,"90th_percentile":5968.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4209.48,"10th_percentile":4209.48,"90th_percentile":5581.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":16608.34,"10th_percentile":16608.34,"90th_percentile":16608.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5715.9,"10th_percentile":5715.9,"90th_percentile":6374.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"15","median_amount":17659.57,"10th_percentile":8998.59,"90th_percentile":20935.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3546.4,"10th_percentile":3546.4,"90th_percentile":3546.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":10038.69,"10th_percentile":10038.69,"90th_percentile":10038.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":689.86,"10th_percentile":689.86,"90th_percentile":689.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":4054.38,"10th_percentile":4054.38,"90th_percentile":7742.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":2101.24,"10th_percentile":2101.24,"90th_percentile":2101.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":9898.07,"10th_percentile":5554.81,"90th_percentile":27297.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":10959.58,"10th_percentile":8269.0,"90th_percentile":25494.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2100.21,"10th_percentile":2100.21,"90th_percentile":2100.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":11487.98,"10th_percentile":11487.98,"90th_percentile":11487.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":7485.44,"10th_percentile":5388.29,"90th_percentile":29699.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"12","median_amount":3528.37,"10th_percentile":3523.37,"90th_percentile":3536.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":27777.0,"10th_percentile":10165.72,"90th_percentile":27777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":8120.72,"10th_percentile":8120.72,"90th_percentile":8120.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"35","median_amount":25291.87,"10th_percentile":13486.18,"90th_percentile":42463.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":9589.23,"10th_percentile":8269.0,"90th_percentile":15189.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3526.17,"10th_percentile":3523.37,"90th_percentile":3531.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1022.54,"10th_percentile":1022.54,"90th_percentile":1022.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3523.38,"10th_percentile":3273.21,"90th_percentile":3532.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":23201.44,"10th_percentile":15965.78,"90th_percentile":26458.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3335.08,"10th_percentile":3335.08,"90th_percentile":3335.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":20531.18,"10th_percentile":15638.25,"90th_percentile":27686.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":5193.28,"10th_percentile":5193.28,"90th_percentile":7393.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7741.51,"10th_percentile":7741.51,"90th_percentile":7741.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":17910.72,"10th_percentile":17910.72,"90th_percentile":17910.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":38740.79,"10th_percentile":24495.83,"90th_percentile":40827.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":18067.67,"10th_percentile":18067.67,"90th_percentile":20312.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5200.26,"10th_percentile":5200.26,"90th_percentile":5201.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3921.56,"10th_percentile":3921.56,"90th_percentile":3921.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4806.19,"10th_percentile":4806.19,"90th_percentile":4806.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":31716.09,"10th_percentile":31716.09,"90th_percentile":31716.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":696.28,"10th_percentile":696.28,"90th_percentile":696.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":16394.6,"10th_percentile":16394.6,"90th_percentile":16394.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1830.66,"10th_percentile":1627.4,"90th_percentile":2002.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":7690.5,"10th_percentile":7690.5,"90th_percentile":7690.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5474.0,"10th_percentile":5474.0,"90th_percentile":5474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"12","median_amount":10113.84,"10th_percentile":8226.95,"90th_percentile":14679.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1687.59,"10th_percentile":1687.59,"90th_percentile":1687.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1602.9,"10th_percentile":1602.9,"90th_percentile":1602.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1743.95,"10th_percentile":1743.95,"90th_percentile":1743.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":5734.94,"10th_percentile":5734.94,"90th_percentile":5734.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":753.94,"10th_percentile":753.94,"90th_percentile":753.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":301.56,"10th_percentile":40.0,"90th_percentile":459.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":139.3,"10th_percentile":139.3,"90th_percentile":139.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4149.55,"10th_percentile":4149.55,"90th_percentile":4433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":3240.59,"10th_percentile":1095.41,"90th_percentile":4495.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2033.82,"10th_percentile":2033.82,"90th_percentile":2033.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.71,"10th_percentile":307.71,"90th_percentile":460.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":234.83,"10th_percentile":234.83,"90th_percentile":234.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":241.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1498.67,"10th_percentile":987.53,"90th_percentile":2690.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":392.97,"10th_percentile":392.97,"90th_percentile":392.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":710.35,"10th_percentile":554.46,"90th_percentile":714.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":2497.87,"10th_percentile":2497.87,"90th_percentile":4884.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":323.61,"10th_percentile":323.61,"90th_percentile":323.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":363.13,"10th_percentile":315.46,"90th_percentile":1069.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":712.17,"10th_percentile":627.59,"90th_percentile":714.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":541.48,"10th_percentile":541.48,"90th_percentile":541.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":3982.54,"10th_percentile":3982.54,"90th_percentile":3982.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":996.74,"10th_percentile":909.5,"90th_percentile":1371.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1788.12,"10th_percentile":1788.12,"90th_percentile":1788.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":4296.91,"10th_percentile":3974.34,"90th_percentile":6112.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1288.28,"10th_percentile":1288.28,"90th_percentile":1288.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":867.85,"10th_percentile":867.85,"90th_percentile":867.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":728.73,"10th_percentile":728.73,"90th_percentile":728.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1370.45,"10th_percentile":1370.45,"90th_percentile":1370.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1715.68,"10th_percentile":1715.68,"90th_percentile":3764.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":6851.04,"10th_percentile":3055.93,"90th_percentile":7682.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"23","median_amount":2336.93,"10th_percentile":2203.49,"90th_percentile":2336.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3566.22,"10th_percentile":3566.22,"90th_percentile":3566.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"24","median_amount":12016.52,"10th_percentile":10916.53,"90th_percentile":14367.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2329.93,"10th_percentile":2205.29,"90th_percentile":2337.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"21","median_amount":2101.81,"10th_percentile":1677.05,"90th_percentile":2337.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":6152.84,"10th_percentile":5403.72,"90th_percentile":8077.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2179.32,"10th_percentile":2179.32,"90th_percentile":2179.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"123","median_amount":307.2,"10th_percentile":103.27,"90th_percentile":756.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"132","median_amount":89.95,"10th_percentile":82.49,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"71","median_amount":137.69,"10th_percentile":82.69,"90th_percentile":275.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"65","median_amount":129.01,"10th_percentile":104.23,"90th_percentile":1268.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":1393.82,"10th_percentile":1393.82,"90th_percentile":1393.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"673","median_amount":535.82,"10th_percentile":347.3,"90th_percentile":1841.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"67","median_amount":323.9,"10th_percentile":219.98,"90th_percentile":874.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.9,"10th_percentile":143.9,"90th_percentile":143.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20.05,"10th_percentile":20.05,"90th_percentile":95.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":89.95,"10th_percentile":85.93,"90th_percentile":124.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":53.57,"10th_percentile":36.88,"90th_percentile":101.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"46","median_amount":83.41,"10th_percentile":65.46,"90th_percentile":90.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"178","median_amount":316.47,"10th_percentile":155.2,"90th_percentile":1095.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":92.65,"10th_percentile":92.65,"90th_percentile":92.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"141","median_amount":707.78,"10th_percentile":159.12,"90th_percentile":1259.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"199","median_amount":108.63,"10th_percentile":103.96,"90th_percentile":209.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"74","median_amount":166.28,"10th_percentile":111.28,"90th_percentile":320.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"62","median_amount":883.0,"10th_percentile":163.07,"90th_percentile":2619.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":968.49,"10th_percentile":968.49,"90th_percentile":968.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"593","median_amount":1753.27,"10th_percentile":624.05,"90th_percentile":3185.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"80","median_amount":1066.28,"10th_percentile":343.22,"90th_percentile":2046.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.91,"10th_percentile":84.13,"90th_percentile":299.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.97,"10th_percentile":103.96,"90th_percentile":112.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"86","median_amount":108.63,"10th_percentile":103.96,"90th_percentile":217.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"43","median_amount":104.26,"10th_percentile":53.57,"90th_percentile":264.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1445.0,"10th_percentile":1445.0,"90th_percentile":1445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"49","median_amount":110.85,"10th_percentile":98.91,"90th_percentile":286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"141","median_amount":1061.44,"10th_percentile":343.58,"90th_percentile":1978.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.4,"10th_percentile":89.51,"90th_percentile":460.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"58","median_amount":759.2,"10th_percentile":354.65,"90th_percentile":1571.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"98","median_amount":247.94,"10th_percentile":108.63,"90th_percentile":467.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"26","median_amount":377.96,"10th_percentile":292.96,"90th_percentile":377.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"33","median_amount":3288.12,"10th_percentile":1544.08,"90th_percentile":4093.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2829.6,"10th_percentile":2829.6,"90th_percentile":2829.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"239","median_amount":5889.31,"10th_percentile":1674.93,"90th_percentile":7843.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"14","median_amount":3974.0,"10th_percentile":3198.15,"90th_percentile":5189.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":197.55,"10th_percentile":197.55,"90th_percentile":209.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":258.71,"10th_percentile":60.81,"90th_percentile":712.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":246.93,"10th_percentile":202.83,"90th_percentile":311.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":230.16,"10th_percentile":158.46,"90th_percentile":310.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3456.34,"10th_percentile":3456.34,"90th_percentile":3456.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"38","median_amount":246.94,"10th_percentile":197.55,"90th_percentile":441.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"73","median_amount":3651.37,"10th_percentile":1040.2,"90th_percentile":4399.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":214.15,"10th_percentile":209.24,"90th_percentile":2638.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"56","median_amount":1220.95,"10th_percentile":681.75,"90th_percentile":2908.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"67","median_amount":561.84,"10th_percentile":462.13,"90th_percentile":575.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"29","median_amount":852.34,"10th_percentile":643.01,"90th_percentile":857.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"19","median_amount":884.47,"10th_percentile":550.9,"90th_percentile":2495.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":884.47,"10th_percentile":884.47,"90th_percentile":884.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"192","median_amount":2153.49,"10th_percentile":1922.76,"90th_percentile":5424.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"20","median_amount":1576.66,"10th_percentile":1070.95,"90th_percentile":4448.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":560.13,"10th_percentile":560.13,"90th_percentile":560.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":489.43,"10th_percentile":489.43,"90th_percentile":489.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1011.27,"10th_percentile":1011.27,"90th_percentile":1011.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":563.13,"10th_percentile":413.13,"90th_percentile":668.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":396.58,"10th_percentile":284.38,"90th_percentile":571.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":909.16,"10th_percentile":909.16,"90th_percentile":909.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"19","median_amount":560.13,"10th_percentile":448.11,"90th_percentile":565.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"55","median_amount":1335.16,"10th_percentile":1068.13,"90th_percentile":3417.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":552.44,"10th_percentile":552.44,"90th_percentile":577.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"29","median_amount":999.4,"10th_percentile":265.92,"90th_percentile":1390.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"29","median_amount":248.51,"10th_percentile":181.86,"90th_percentile":448.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":345.64,"10th_percentile":278.36,"90th_percentile":680.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3244.22,"10th_percentile":2705.72,"90th_percentile":3320.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"96","median_amount":5116.22,"10th_percentile":3177.82,"90th_percentile":10997.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1500.0,"10th_percentile":1284.92,"90th_percentile":3443.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":466.29,"10th_percentile":466.29,"90th_percentile":466.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":185.57,"10th_percentile":112.66,"90th_percentile":451.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":289.97,"10th_percentile":278.4,"90th_percentile":365.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"12","median_amount":444.51,"10th_percentile":182.76,"90th_percentile":445.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"15","median_amount":3474.0,"10th_percentile":2128.85,"90th_percentile":6401.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":460.85,"10th_percentile":460.85,"90th_percentile":460.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"42","median_amount":1015.33,"10th_percentile":486.37,"90th_percentile":1670.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"74","median_amount":366.32,"10th_percentile":168.83,"90th_percentile":489.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"18","median_amount":535.56,"10th_percentile":308.42,"90th_percentile":724.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"42","median_amount":3812.84,"10th_percentile":1948.13,"90th_percentile":4156.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"241","median_amount":7789.47,"10th_percentile":6460.48,"90th_percentile":11793.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"28","median_amount":3974.0,"10th_percentile":1168.18,"90th_percentile":7114.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":266.83,"10th_percentile":266.83,"90th_percentile":366.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":383.43,"10th_percentile":383.43,"90th_percentile":383.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":371.83,"10th_percentile":363.94,"90th_percentile":480.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":372.83,"10th_percentile":267.36,"90th_percentile":569.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":6193.18,"10th_percentile":6193.18,"90th_percentile":6193.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"32","median_amount":364.84,"10th_percentile":217.84,"90th_percentile":369.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"71","median_amount":4517.74,"10th_percentile":2921.37,"90th_percentile":7089.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":265.25,"10th_percentile":228.78,"90th_percentile":7369.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1617.9,"10th_percentile":1471.08,"90th_percentile":1895.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":1055.61,"10th_percentile":1055.61,"90th_percentile":1055.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1235.36,"10th_percentile":1235.36,"90th_percentile":1235.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":6811.72,"10th_percentile":6811.72,"90th_percentile":8613.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":8003.85,"10th_percentile":2853.63,"90th_percentile":9136.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":550.81,"10th_percentile":550.81,"90th_percentile":893.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":758.1,"10th_percentile":758.1,"90th_percentile":758.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":4902.23,"10th_percentile":4902.23,"90th_percentile":5577.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":756.44,"10th_percentile":756.44,"90th_percentile":1430.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":214.5,"10th_percentile":214.5,"90th_percentile":214.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":628.32,"10th_percentile":628.32,"90th_percentile":628.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":1172.04,"10th_percentile":1172.04,"90th_percentile":1172.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"15","median_amount":2252.41,"10th_percentile":2133.26,"90th_percentile":2252.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.34,"10th_percentile":814.34,"90th_percentile":814.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":336.53,"10th_percentile":336.53,"90th_percentile":336.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":420.31,"10th_percentile":420.31,"90th_percentile":420.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1132.1,"10th_percentile":1061.35,"90th_percentile":1132.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":554.88,"10th_percentile":554.88,"90th_percentile":554.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"12","median_amount":3450.45,"10th_percentile":3342.21,"90th_percentile":3550.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1870.53,"10th_percentile":1870.53,"90th_percentile":1870.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":350.53,"10th_percentile":350.53,"90th_percentile":350.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":353.88,"10th_percentile":353.88,"90th_percentile":353.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"14","median_amount":3788.22,"10th_percentile":1305.22,"90th_percentile":4194.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"29","median_amount":1339.09,"10th_percentile":1177.64,"90th_percentile":1897.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"13","median_amount":2041.29,"10th_percentile":1530.97,"90th_percentile":2041.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"12","median_amount":2309.5,"10th_percentile":1963.07,"90th_percentile":2309.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"56","median_amount":6605.24,"10th_percentile":5589.6,"90th_percentile":6605.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2982.66,"10th_percentile":2684.39,"90th_percentile":7597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1235.64,"10th_percentile":1235.64,"90th_percentile":1235.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1975.51,"10th_percentile":1975.51,"90th_percentile":1975.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1342.07,"10th_percentile":971.54,"90th_percentile":1903.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":957.84,"10th_percentile":829.05,"90th_percentile":2050.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1746.78,"10th_percentile":1238.65,"90th_percentile":1898.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":3631.88,"10th_percentile":3298.34,"90th_percentile":4122.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":5681.91,"10th_percentile":3543.14,"90th_percentile":6174.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"29","median_amount":1494.05,"10th_percentile":1294.05,"90th_percentile":3323.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2280.69,"10th_percentile":1769.07,"90th_percentile":2630.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":7136.56,"10th_percentile":7136.56,"90th_percentile":21250.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":7322.56,"10th_percentile":7322.56,"90th_percentile":7322.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"21","median_amount":8947.89,"10th_percentile":8174.8,"90th_percentile":9724.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5685.57,"10th_percentile":5685.57,"90th_percentile":5685.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1490.05,"10th_percentile":1490.05,"90th_percentile":2932.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1272.71,"10th_percentile":1272.71,"90th_percentile":1710.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1495.06,"10th_percentile":1245.06,"90th_percentile":3324.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":4298.84,"10th_percentile":4298.84,"90th_percentile":5576.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1534.75,"10th_percentile":1534.75,"90th_percentile":1534.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":100.87,"10th_percentile":100.87,"90th_percentile":1021.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":174.17,"10th_percentile":174.17,"90th_percentile":174.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":58.49,"10th_percentile":58.49,"90th_percentile":58.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"12","median_amount":470.55,"10th_percentile":433.82,"90th_percentile":999.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":128.69,"10th_percentile":128.69,"90th_percentile":128.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.23,"10th_percentile":51.23,"90th_percentile":51.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":75.21,"10th_percentile":75.21,"90th_percentile":75.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":298.3,"10th_percentile":298.3,"90th_percentile":298.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":928.21,"10th_percentile":928.21,"90th_percentile":3677.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":153.65,"10th_percentile":153.65,"90th_percentile":153.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":2955.44,"10th_percentile":2955.44,"90th_percentile":2955.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":384.56,"10th_percentile":384.56,"90th_percentile":384.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":4564.51,"10th_percentile":4564.51,"90th_percentile":4564.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5268.55,"10th_percentile":5268.55,"90th_percentile":5268.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":486.1,"10th_percentile":486.1,"90th_percentile":486.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":114.56,"10th_percentile":114.56,"90th_percentile":114.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1208.07,"10th_percentile":1208.07,"90th_percentile":1568.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":439.22,"10th_percentile":439.22,"90th_percentile":439.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1277.33,"10th_percentile":1277.33,"90th_percentile":1277.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":20267.91,"10th_percentile":20267.91,"90th_percentile":20267.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3543.2,"10th_percentile":3543.2,"90th_percentile":3543.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":12464.77,"10th_percentile":1516.85,"90th_percentile":57389.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1329.83,"10th_percentile":1329.83,"90th_percentile":1329.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2413.34,"10th_percentile":2413.34,"90th_percentile":2413.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":3689.0,"10th_percentile":3689.0,"90th_percentile":3689.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1196.2,"10th_percentile":1196.2,"90th_percentile":2997.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":261.26,"10th_percentile":261.26,"90th_percentile":261.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"34","median_amount":18550.9,"10th_percentile":1966.06,"90th_percentile":48640.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":204.07,"10th_percentile":145.99,"90th_percentile":3343.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1302.24,"10th_percentile":1185.17,"90th_percentile":1302.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"31","median_amount":385.22,"10th_percentile":385.22,"90th_percentile":798.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"34","median_amount":215.74,"10th_percentile":196.35,"90th_percentile":2019.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":417.14,"10th_percentile":256.2,"90th_percentile":727.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"80","median_amount":2054.15,"10th_percentile":931.02,"90th_percentile":18367.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"22","median_amount":1460.78,"10th_percentile":1168.67,"90th_percentile":1656.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":216.12,"10th_percentile":209.9,"90th_percentile":1462.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14061.29,"10th_percentile":4307.23,"90th_percentile":29427.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"17","median_amount":298.92,"10th_percentile":172.19,"90th_percentile":2615.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"18","median_amount":1075.0,"10th_percentile":411.33,"90th_percentile":14518.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":226.22,"10th_percentile":226.22,"90th_percentile":226.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"20","median_amount":4835.23,"10th_percentile":1580.27,"90th_percentile":36676.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"19","median_amount":1730.89,"10th_percentile":612.37,"90th_percentile":12497.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1743.17,"10th_percentile":1743.17,"90th_percentile":1743.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":24007.03,"10th_percentile":24007.03,"90th_percentile":24007.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"27","median_amount":29841.02,"10th_percentile":15299.94,"90th_percentile":74314.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":470.56,"10th_percentile":413.36,"90th_percentile":609.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"11","median_amount":4216.8,"10th_percentile":496.22,"90th_percentile":10587.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":571.29,"10th_percentile":571.29,"90th_percentile":571.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3832.98,"10th_percentile":1147.91,"90th_percentile":5484.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":450.99,"10th_percentile":383.34,"90th_percentile":5833.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":160.49,"10th_percentile":144.2,"90th_percentile":161.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":244.65,"10th_percentile":183.49,"90th_percentile":244.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":710.22,"10th_percentile":710.22,"90th_percentile":795.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"47","median_amount":711.29,"10th_percentile":403.4,"90th_percentile":795.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":397.72,"10th_percentile":387.72,"90th_percentile":582.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.84,"10th_percentile":159.84,"90th_percentile":159.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":139.03,"10th_percentile":99.7,"90th_percentile":144.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"15","median_amount":447.44,"10th_percentile":246.59,"90th_percentile":447.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"45","median_amount":825.68,"10th_percentile":404.59,"90th_percentile":1555.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"27","median_amount":318.12,"10th_percentile":233.09,"90th_percentile":320.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"20","median_amount":481.92,"10th_percentile":401.92,"90th_percentile":486.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"28","median_amount":669.91,"10th_percentile":366.36,"90th_percentile":1126.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"133","median_amount":1585.02,"10th_percentile":716.16,"90th_percentile":2657.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"19","median_amount":894.07,"10th_percentile":356.81,"90th_percentile":1793.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":447.81,"10th_percentile":447.81,"90th_percentile":447.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":318.12,"10th_percentile":225.02,"90th_percentile":319.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":194.52,"10th_percentile":194.52,"90th_percentile":245.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.52,"10th_percentile":282.35,"90th_percentile":1310.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"34","median_amount":1214.88,"10th_percentile":448.0,"90th_percentile":1994.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.16,"10th_percentile":328.16,"90th_percentile":328.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1817.16,"10th_percentile":1817.16,"90th_percentile":2006.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":860.17,"10th_percentile":860.17,"90th_percentile":860.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":987.44,"10th_percentile":987.44,"90th_percentile":1052.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":5206.18,"10th_percentile":5206.18,"90th_percentile":5206.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"15","median_amount":1546.71,"10th_percentile":1160.0,"90th_percentile":1854.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":246.83,"10th_percentile":246.83,"90th_percentile":246.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":1106.51,"10th_percentile":1106.51,"90th_percentile":1106.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"22","median_amount":4581.59,"10th_percentile":1590.83,"90th_percentile":5309.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"24","median_amount":1041.34,"10th_percentile":941.34,"90th_percentile":1043.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1193.12,"10th_percentile":1193.12,"90th_percentile":1590.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4796.0,"10th_percentile":4446.0,"90th_percentile":4940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"52","median_amount":7215.1,"10th_percentile":6563.42,"90th_percentile":8361.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4040.46,"10th_percentile":3636.41,"90th_percentile":6856.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1082.81,"10th_percentile":1082.81,"90th_percentile":1082.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1041.24,"10th_percentile":1041.24,"90th_percentile":1041.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":754.01,"10th_percentile":754.01,"90th_percentile":754.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.34,"10th_percentile":1039.34,"90th_percentile":1040.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"13","median_amount":4473.36,"10th_percentile":3885.68,"90th_percentile":5267.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1071.02,"10th_percentile":1071.02,"90th_percentile":1071.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":672.89,"10th_percentile":672.89,"90th_percentile":672.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":3295.42,"10th_percentile":3295.42,"90th_percentile":3415.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.71,"10th_percentile":128.71,"90th_percentile":128.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":651.0,"10th_percentile":205.58,"90th_percentile":684.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":238.11,"10th_percentile":183.98,"90th_percentile":277.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":92.88,"10th_percentile":77.88,"90th_percentile":92.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":224.64,"10th_percentile":224.64,"90th_percentile":224.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":182.5,"10th_percentile":182.5,"90th_percentile":182.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"38","median_amount":1962.05,"10th_percentile":596.29,"90th_percentile":3457.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":715.11,"10th_percentile":715.11,"90th_percentile":715.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":265.85,"10th_percentile":241.16,"90th_percentile":366.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30.73,"10th_percentile":24.85,"90th_percentile":37.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":262.63,"10th_percentile":194.68,"90th_percentile":348.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":341.38,"10th_percentile":234.89,"90th_percentile":2239.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"18","median_amount":84.59,"10th_percentile":21.34,"90th_percentile":201.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"15","median_amount":120.78,"10th_percentile":120.78,"90th_percentile":134.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":201.56,"10th_percentile":201.56,"90th_percentile":201.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":133.42,"10th_percentile":133.42,"90th_percentile":133.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"38","median_amount":590.76,"10th_percentile":298.59,"90th_percentile":3011.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":123.25,"10th_percentile":123.25,"90th_percentile":123.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5.92,"10th_percentile":5.92,"90th_percentile":5.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.92,"10th_percentile":114.92,"90th_percentile":139.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":67.78,"10th_percentile":36.56,"90th_percentile":95.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":1554.75,"10th_percentile":1554.75,"90th_percentile":1554.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":10582.68,"10th_percentile":10582.68,"90th_percentile":10582.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1560.01,"10th_percentile":1560.01,"90th_percentile":1560.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":201.3,"10th_percentile":201.3,"90th_percentile":201.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":143.82,"10th_percentile":142.4,"90th_percentile":5655.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":103.97,"10th_percentile":103.97,"90th_percentile":103.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"1 through 10","median_amount":79.88,"10th_percentile":79.88,"90th_percentile":79.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alteplase recombinant","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":3503.85,"10th_percentile":3503.85,"90th_percentile":3503.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":2123.41,"10th_percentile":2123.41,"90th_percentile":2123.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":451.97,"10th_percentile":451.97,"90th_percentile":451.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":764.75,"10th_percentile":764.75,"90th_percentile":764.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":84.01,"10th_percentile":84.01,"90th_percentile":84.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":137.09,"10th_percentile":137.09,"90th_percentile":137.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"11","median_amount":132.3,"10th_percentile":132.3,"90th_percentile":335.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"508","median_amount":92.97,"10th_percentile":22.67,"90th_percentile":262.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"612","median_amount":35.58,"10th_percentile":11.3,"90th_percentile":97.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"233","median_amount":52.64,"10th_percentile":18.4,"90th_percentile":186.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"320","median_amount":53.8,"10th_percentile":25.03,"90th_percentile":129.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"17","median_amount":106.43,"10th_percentile":60.5,"90th_percentile":223.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"2406","median_amount":560.08,"10th_percentile":184.17,"90th_percentile":1514.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"253","median_amount":205.0,"10th_percentile":47.67,"90th_percentile":647.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23.8,"10th_percentile":13.27,"90th_percentile":29.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":34.07,"10th_percentile":19.07,"90th_percentile":57.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":37.16,"10th_percentile":37.16,"90th_percentile":37.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"272","median_amount":32.99,"10th_percentile":9.52,"90th_percentile":96.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"130","median_amount":15.0,"10th_percentile":4.18,"90th_percentile":82.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"216","median_amount":35.34,"10th_percentile":12.93,"90th_percentile":99.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"632","median_amount":62.31,"10th_percentile":20.0,"90th_percentile":197.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"48","median_amount":36.76,"10th_percentile":3.88,"90th_percentile":90.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"74","median_amount":778.72,"10th_percentile":248.53,"90th_percentile":1910.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"135","median_amount":204.58,"10th_percentile":78.45,"90th_percentile":441.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"59","median_amount":355.0,"10th_percentile":125.62,"90th_percentile":867.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"28","median_amount":900.0,"10th_percentile":309.0,"90th_percentile":1854.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"279","median_amount":1458.08,"10th_percentile":527.31,"90th_percentile":3483.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"28","median_amount":822.32,"10th_percentile":239.55,"90th_percentile":2944.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.74,"10th_percentile":52.51,"90th_percentile":389.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":223.19,"10th_percentile":101.11,"90th_percentile":499.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":215.16,"10th_percentile":103.16,"90th_percentile":475.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"23","median_amount":163.09,"10th_percentile":79.45,"90th_percentile":437.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"85","median_amount":1414.36,"10th_percentile":490.0,"90th_percentile":3901.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.17,"10th_percentile":78.05,"90th_percentile":353.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"95","median_amount":768.0,"10th_percentile":154.67,"90th_percentile":769.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"61","median_amount":101.05,"10th_percentile":101.05,"90th_percentile":103.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"50","median_amount":154.67,"10th_percentile":154.67,"90th_percentile":154.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"41","median_amount":550.82,"10th_percentile":536.82,"90th_percentile":550.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":550.82,"10th_percentile":550.82,"90th_percentile":550.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"297","median_amount":1209.45,"10th_percentile":1209.45,"90th_percentile":1211.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"27","median_amount":678.25,"10th_percentile":677.3,"90th_percentile":991.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.05,"10th_percentile":101.05,"90th_percentile":101.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":105.09,"10th_percentile":105.09,"90th_percentile":105.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":101.05,"10th_percentile":101.05,"90th_percentile":103.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":65.61,"10th_percentile":47.04,"90th_percentile":68.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":666.14,"10th_percentile":666.14,"90th_percentile":666.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"13","median_amount":101.06,"10th_percentile":101.06,"90th_percentile":104.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"62","median_amount":761.95,"10th_percentile":750.92,"90th_percentile":761.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104.08,"10th_percentile":104.08,"90th_percentile":104.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"1 through 10","median_amount":132.2,"10th_percentile":132.2,"90th_percentile":132.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":655.99,"10th_percentile":540.22,"90th_percentile":1559.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1377.94,"10th_percentile":1377.94,"90th_percentile":1377.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.1,"10th_percentile":80.1,"90th_percentile":80.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"12","median_amount":1024.41,"10th_percentile":192.66,"90th_percentile":2012.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":417.78,"10th_percentile":150.03,"90th_percentile":2007.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":900.0,"10th_percentile":173.81,"90th_percentile":1854.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":103.08,"10th_percentile":56.72,"90th_percentile":112.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"46","median_amount":1565.79,"10th_percentile":532.12,"90th_percentile":3543.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":767.26,"10th_percentile":767.26,"90th_percentile":831.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":10.49,"10th_percentile":6.71,"90th_percentile":39.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"The Alliance","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 57] [Observation (%BC): 57] [Emergency Department (%BC): 57] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57] [Physical Therapy (%BC): 57] [Respiratory Services/Therapy  (%BC): 57] [Speech Therapy (%BC): 57] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 4000] [Ambulance--Land ($): 400] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62] [Stereotactic Radiosurgery ($): 16845] [Stereotactic Radiosurgery-Fractionated ($): 615] [Observation ($): 3689] [ED Level 1--99281 ($): 1106] [ED Level 2--99282 ($): 1475] [ED Level 3--99283 ($): 1721] [ED Level 4--99284 ($): 2459] [ED Level 5--99285 ($): 3074] [Critical Care ($): 4672] [Urgent Care ($): 259] [Cardiac Rehabilitation Therapy ($): 207] [Cardiac Stress Test (%BC): 62] [Cardiology (%BC): 62] [Echocardiology (%BC): 62] [EKG/ECG  (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab (%BC): 62] [EEG (%BC): 62] [EMG ($): 1106] [MEG ($): 1656] [Neuropsychological Testing and Biofeedback ($): 983] [Sleep Studies (%BC): 62] [Chemotherapy (%BC): 62] [Nuclear Medicine (%BC): 62] [Oncology (%BC): 62] [Radiation Therapy  (%BC): 62] [CT OP Scan (%BC): 62] [MRI OP (%BC): 62] [Imaging Services (%BC): 62] [Mammography-Diagnostic (%BC): 62] [Mammography-Screening (%BC): 62] [Positron Emission Tomography (%BC): 62] [Radiology (%BC): 63] [Ultrasound Imaging (%BC): 62] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 245] [Physical Therapy ($): 245] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy ($): 245] [Ambulance--Air  (%BC): 62] [Ambulance--Land  (%BC): 62] [Hyperbarics ($): 1553] [IV Therapy (%BC): 62] [Pulmonary Function ($): 615] [Pulmonary Rehabilitation ($): 245]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.65] [Cardiac Cath (%BC): 63.5] [Laparoscopy (%BC): 60 Maximum Reimbursement 25000] [Observation (%BC): 63.5 Maximum Reimbursement 4000] [Emergency Department (%BC): 45] [CT Scan OP ($): 826] [MRI OP ($): 949] [Radiology (%BC): 63.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 62.65] [Physical Therapy (%BC): 62.65] [Respiratory Services/Therapy  (%BC): 62.65] [Speech Therapy (%BC): 62.65] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 62.65]","count":"1 through 10","median_amount":138.76,"10th_percentile":138.76,"90th_percentile":138.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 23]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qhp Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":39.92,"10th_percentile":39.92,"90th_percentile":39.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Ppo/Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 10401] [Ablation ($): 62867] [Cardiac Cath ($): 21503] [Lithotripsy ($): 28610] [PTCA ($): 40470] [Observation ($): 12263] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 749] [ED Level 3--99283 ($): 2361] [ED Level 4--99284 ($): 4562] [ED Level 5--99285 ($): 4562] [Critical Care-99291 ($): 11130] [Urgent Care ($): 673] [Cardiac Rehabilitation Therapy ($): 242] [Electrophysiology and Mapping Studies ($): 62867] [Sleep Studies-Attended ($): 5088] [Sleep Studies-Unattended ($): 1454] [CT Scan OP ($): 3392] [MRI OP ($): 4216] [Mammography-Diagnostic ($): 508] [Mammography-Screening ($): 508] [Positron Emission Tomography ($): 6588] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 909] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 318] [Physical Therapy ($): 318] [Resp. Services/Therapy ($): 242] [Speech Therapy ($): 318] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Preferred/Blue Preferred Plus Hmo/Pos","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 7306] [Ablation ($): 54209] [Cardiac Cath ($): 18551] [Lithotripsy ($): 24898] [PTCA ($): 34895] [Observation ($): 11253] [ED Level 1--99281 ($): 677] [ED Level 2--99282 ($): 677] [ED Level 3--99283 ($): 1967] [ED Level 4--99284 ($): 3781] [ED Level 5--99285 ($): 3781] [Critical Care-99291 ($): 10512] [Urgent Care ($): 523] [Cardiac Rehabilitation Therapy ($): 211] [Electrophysiology and Mapping Studies ($): 54209] [Sleep Studies-Attended ($): 4543] [Sleep Studies-Unattended ($): 1212] [CT Scan OP ($): 2800] [MRI OP ($): 3643] [Mammography-Diagnostic ($): 439] [Mammography-Screening ($): 439] [Positron Emission Tomography ($): 4985] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 757] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 46] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 46] [Occupational Therapy ($): 266] [Physical Therapy ($): 266] [Resp. Services/Therapy ($): 211] [Speech Therapy ($): 266] [Mental Health (%BC): 50] [OP ECT Mental Health (%BC): 46] [Other Pharmacy ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 46] [Ambulance--Air  (%BC): 46] [IV Therapy (%BC): 55] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Illinois Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 51.6] [OP Surgery  (%BC): 51.6] [Observation (%BC): 51.6] [Emergency Department (%BC): 51.6] [Occupational Therapy (%BC): 51.6] [Physical Therapy (%BC): 51.6] [Respiratory Services/Therapy  (%BC): 51.6] [Speech Therapy (%BC): 51.6] [All Other OP (%BC): 51.6]","count":"1 through 10","median_amount":238.96,"10th_percentile":238.96,"90th_percentile":2970.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 56] [Cardiac Cath (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [Urgent Care (%BC): 56] [Chemotherapy (%BC): 56] [CT Scan OP ($): 1575.00] [MRI OP ($): 4172.70] [Positron Emission Tomography ($): 6520.50] [Radiology (%BC): 56] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy  (%BC): 56] [Speech Therapy (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":235.45,"10th_percentile":235.45,"90th_percentile":235.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Payment Systems","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Advantage Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26.08,"10th_percentile":26.08,"90th_percentile":26.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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